Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China.
Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China.
Oral Oncol. 2018 Feb;77:16-21. doi: 10.1016/j.oraloncology.2017.12.004. Epub 2017 Dec 12.
To evaluate treatment outcomes, failure patterns and late toxicities in patients with nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT) in 6 public hospitals in Hong Kong over a 10-year period from 2001 to 2010.
Eligible patients were identified through the Hong Kong Cancer Registry data base. Clinical information was retrieved and verified by oncologists working in the individual centers. Treatment details, survival outcomes and late toxicities were analyzed.
A total of 3328 patients were recruited. The median follow-up time was 80.2 months. The 8-year actuarial overall survival (OS), local failure-free survival (LFFS), regional failure-free survival (RFFS), distant failure free survival (DFFS), progression-free survival (PFS) for the whole group was 68.5%, 85.8%, 91.5%, 81.5% and 62.6% respectively. Male gender, older age, advanced T and N stage were adverse prognostic factors for OS, DFFS and PFS, whereas use of chemotherapy in form of concurrent chemo-irradiation (CRT), neoadjuvant + CRT, or CRT + adjuvant chemotherapy were favorable prognostic factors for OS and PFS. The local control was adversely affected by advanced T stage. N stage remained as the single adverse prognostic factor for regional control. Distant metastasis was the commonest site of failure.
IMRT is an effective treatment for NPC with excellent overall loco-regional control. Distant metastasis is the major site of failure. Concurrent chemotherapy with cisplatin has an established role in NPC patients treated by IMRT.
评估 2001 年至 2010 年十年间香港六家公立医院采用调强放疗（IMRT）治疗的鼻咽癌（NPC）患者的治疗结果、失败模式和晚期毒性。
通过香港癌症登记数据库确定合格患者。临床信息由在各个中心工作的肿瘤学家检索和验证。分析了治疗细节、生存结果和晚期毒性。
共招募了 3328 名患者。中位随访时间为 80.2 个月。全组患者 8 年总生存率（OS）、局部无失败生存率（LFFS）、区域无失败生存率（RFFS）、远处无失败生存率（DFFS）、无进展生存率（PFS）分别为 68.5%、85.8%、91.5%、81.5%和 62.6%。男性、年龄较大、T 和 N 期较晚是 OS、DFFS 和 PFS 的不良预后因素，而同期放化疗（CRT）、新辅助+CRT 或 CRT+辅助化疗等形式的化疗是 OS 和 PFS 的有利预后因素。局部控制受晚期 T 期的不利影响。N 期仍然是区域控制的唯一不良预后因素。远处转移是最常见的失败部位。
IMRT 是治疗 NPC 的有效方法，具有优异的整体局部控制效果。远处转移是失败的主要部位。顺铂联合化疗在接受 IMRT 治疗的 NPC 患者中具有明确的作用。
