Kunheri Beena, Agarwal Gunjan, Sunil P S, Nair Anoop Ramesan, Pushpaja K U
Department of Radiotherapy, Amrita School of Medicine, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India.
Indian J Cancer. 2017 Jul-Sep;54(3):502-507. doi: 10.4103/ijc.IJC_287_17.
The majority of nasopharyngeal carcinoma (NPC) reports on the outcome and prognostic factors are from endemic high-risk regions. Data on the outcome of Indian patients are sparse. In this study, we retrospectively analyzed the outcome of NPC patients treated radically with conformal radiotherapy (RT). The primary objective was to assess the outcome, and the secondary objectives were to assess treatment-related morbidities and the impact of various prognostic factors on the outcome.
Sixty-eight patients with biopsy-proven NPC who received radical conformal RT, i.e., three-dimensional conformal RT or intensity-modulated RT (IMRT) during 2004-2013 were analyzed. All patients received conformal RT with or without chemotherapy. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 20.0) software, IBM, USA. Survival analysis was performed using Kaplan-Meier method. For calculating the hazard ratio of the prognostic factors, univariate and multivariate Cox regression analyses were done. Chi-square test was used to determine the association.
In this study, with a median follow-up of 43 months, the overall survival (OS), disease-free survival, and cause-specific survival were 91, 85.2, and 98.4% at 2 years and 78.3, 72.8, and 88.2% at 3 years, respectively. The locoregional failure was low (3%), and the 5-year cause-specific survival with chemoradiation was excellent (79%), even with 50% of the patients being nonmetastatic Stage IV. Eleven out of 12 failures were distant metastases. The treatment-related late morbidities were acceptable and better with IMRT. Significant prognostic factors affecting the outcome were composite stage of the disease and the interval between diagnosis and treatment initiation.
In locally-advanced NPC, excellent local control is possible with modern conformal RT with concurrent chemotherapy. Distant metastases remain a therapeutic challenge despite systemic chemotherapy. Novel systemic therapies are needed in the future for improving the OS of these patients.
大多数关于鼻咽癌（NPC）治疗结果及预后因素的报告来自鼻咽癌高发流行地区。印度患者的治疗结果数据较为稀少。在本研究中，我们回顾性分析了接受适形放疗（RT）根治性治疗的鼻咽癌患者的治疗结果。主要目的是评估治疗结果，次要目的是评估治疗相关的并发症以及各种预后因素对治疗结果的影响。
分析了68例经活检证实为鼻咽癌且在2004年至2013年间接受根治性适形放疗（即三维适形放疗或调强放疗[IMRT]）的患者。所有患者均接受了适形放疗，部分患者联合化疗。使用美国IBM公司的社会科学统计软件包（SPSS，版本20.0）进行统计分析。采用Kaplan-Meier法进行生存分析。为计算预后因素的风险比，进行了单因素和多因素Cox回归分析。采用卡方检验确定相关性。
在本研究中，中位随访时间为43个月，2年时的总生存率（OS）、无病生存率和疾病特异性生存率分别为91%、85.2%和98.4%，3年时分别为78.3%、72.8%和88.2%。局部区域复发率较低（3%），即使50%的患者为非转移性IV期，放化疗后的5年疾病特异性生存率也很高（79%）。12例复发中有11例为远处转移。治疗相关的晚期并发症是可接受的，IMRT的情况更好。影响治疗结果的显著预后因素是疾病的综合分期以及诊断与开始治疗之间的间隔时间。
在局部晚期鼻咽癌中，采用现代适形放疗联合同步化疗可实现良好的局部控制。尽管进行了全身化疗，远处转移仍然是一个治疗挑战。未来需要新的全身治疗方法来提高这些患者的总生存率。
