诱导化疗后调强放疗靶区缩小的局部晚期鼻咽癌患者的治疗结果：一项前瞻性、多中心、随机临床试验。
Treatment outcomes after reduction of the target volume of intensity-modulated radiotherapy following induction chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: A prospective, multi-center, randomized clinical trial.
机构信息
Chongqing Medical University, China; Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Oncology, the Second People's Hospital of Yibin, China.
出版信息
Radiother Oncol. 2018 Jan;126(1):37-42. doi: 10.1016/j.radonc.2017.07.020. Epub 2017 Aug 29.
PURPOSE
To investigate whether reducing the target volume of intensity-modulated radiotherapy (IMRT) after induction chemotherapy (IC) improves the quality of life (QOL) in locoregionally advanced nasopharyngeal carcinoma (NPC) without decreasing the local control and survival rate.
PATIENTS AND METHODS
A total number of 212 NPC patients staged as III-IVb were randomly assigned to group A (n=97) or group B (n=115) in this prospective clinical trial. All patients received IC followed by cisplatin concurrent with IMRT. IMRT was planned using the images of pre-IC in group A and post-IC in group B.
RESULTS
The dose received by normal tissues in group B was lower than that of group A (P<0.05). The recovery of the dry mouth symptoms in group B was significantly improved than group B. The quality of life (QOL) scores in group B were higher than group A. With a median follow-up of 35months, the 1-year estimated overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS) in group A versus group B were 97.9% vs 97.3%, 90.7% vs 92,2%, 99.0% vs 98.2%, 91.8% vs 94.8%. The 2-year OS, PFS, LRFFS, DMFS in group A versus group B were 93.7% vs 92.9%, 83.4% vs 84.3%, 96.8% vs 95.5%, 86.5% vs 89.5%. The 3-year OS, PFS, LRFFS, DMFS in group A versus group B were 82.3% vs 87%, 74.7% vs 83.4%, 91.8 vs 93.9%, 81.3% vs 88.6%, respectively.
CONCLUSION
Reducing the IMRT target volume after IC did not reduce the local control and survival rate in locoregionally advanced NPC but the doses received by normal tissues were decreased, and the QOL scores were improved.
目的
探讨诱导化疗（IC）后缩小调强放疗（IMRT）靶区能否提高局部晚期鼻咽癌（NPC）患者的生活质量（QOL），而不降低局部控制率和生存率。
方法
本前瞻性临床试验共纳入 212 例 III-IVb 期 NPC 患者，随机分为 A 组（n=97）和 B 组（n=115）。所有患者均接受 IC 联合顺铂同步 IMRT。A 组采用 IC 前的图像进行 IMRT 计划，B 组采用 IC 后的图像进行 IMRT 计划。
结果
B 组正常组织接受的剂量低于 A 组（P<0.05）。B 组口干症状的恢复明显优于 A 组。B 组的生活质量（QOL）评分高于 A 组。中位随访 35 个月后，A 组和 B 组的 1 年总生存率（OS）、无进展生存率（PFS）、局部区域无失败生存率（LRFFS）、无远处转移生存率（DMFS）分别为 97.9% vs 97.3%、90.7% vs 92.2%、99.0% vs 98.2%、91.8% vs 94.8%。A 组和 B 组的 2 年 OS、PFS、LRFFS、DMFS 分别为 93.7% vs 92.9%、83.4% vs 84.3%、96.8% vs 95.5%、86.5% vs 89.5%。A 组和 B 组的 3 年 OS、PFS、LRFFS、DMFS 分别为 82.3% vs 87%、74.7% vs 83.4%、91.8 vs 93.9%、81.3% vs 88.6%。
结论
在局部晚期 NPC 中，IC 后缩小 IMRT 靶区并未降低局部控制率和生存率，但降低了正常组织的剂量，提高了 QOL 评分。
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