Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China.
Department of Oncology Medicine, Yueqing 3rd People's Hospital, Wenzhou, 325600, China.
Radiat Oncol. 2018 Aug 13;13(1):148. doi: 10.1186/s13014-018-1092-0.
In the era of intensity-modulated radiotherapy (IMRT), the role of additional concurrent chemotherapy (CC) to radiotherapy (RT) after induction chemotherapy (IC) compared to IC followed by RT alone remains unclear for stage II-IVB nasopharyngeal carcinoma (NPC) patients. The aim of this study was to evaluate the efficacy and toxicities of IC/RT and IC/CCRT in the treatment of NPC with volumetric modulated arc therapy (VMAT).
From January 2012 to March 2016, a total of 217 NPC patients were retrospectively assessed. Of the 217 patients, 139 patients received IC followed by VMAT alone and 78 patients received IC plus CCRT. Overall survival (OS), progression-free survival (PFS) and toxicities were assessed.
The 5-year OS, PFS rates were 57.5%, 41.8% and 47.8%, 38.4% for the IC/RT and IC/CCRT arms, respectively, without significant difference in survival between the two groups (both p > 0.05). Multivariate analysis indicated that treatment modality (IC/RT vs. IC/CCRT) was not an independent prognostic factor for OS or PFS. Grade 3-4 leukopenia/neutropenia (3.60% vs. 20.51%, p < 0.001), gastrointestinal disorder (nausea/vomiting/diarrhea, 2.16% vs. 41.03%, p < 0.001), mucositis (29.50% vs. 47.44%, p = 0.01) and xerostomia (34.53% vs. 48.72%, p = 0.04) were more frequent in the IC/ CCRT arm than in the IC/RT arm during VMAT.
No significant difference in OS and PFS was observed between IC plus VMAT alone and IC/CCRT in the treatment of stage II-IVB NPC patients, however, more side effects were observed in the IC/CCRT arm.
在调强放疗（IMRT）时代，对于 II-IVB 期鼻咽癌（NPC）患者，与单纯诱导化疗（IC）后放疗（RT）相比，IC 后加用同期化疗（CC）的作用尚不清楚。本研究旨在评估容积调强弧形治疗（VMAT）治疗 NPC 时 IC/RT 和 IC/CCRT 的疗效和毒性。
2012 年 1 月至 2016 年 3 月，回顾性分析了 217 例 NPC 患者。其中 139 例患者接受 IC 后单独 VMAT 治疗，78 例患者接受 IC 加 CCRT。评估总生存（OS）、无进展生存（PFS）和毒性。
IC/RT 和 IC/CCRT 两组的 5 年 OS、PFS 率分别为 57.5%、41.8%和 47.8%、38.4%，两组生存无显著差异（均 p>0.05）。多因素分析表明，治疗方式（IC/RT 与 IC/CCRT）不是 OS 或 PFS 的独立预后因素。3-4 级白细胞减少/中性粒细胞减少（3.60%比 20.51%，p<0.001）、胃肠道紊乱（恶心/呕吐/腹泻，2.16%比 41.03%，p<0.001）、黏膜炎（29.50%比 47.44%，p=0.01）和口干（34.53%比 48.72%，p=0.04）在 IC/CCRT 组较 IC/RT 组更为常见。
在 II-IVB 期 NPC 患者中，IC 加 VMAT 与 IC/CCRT 治疗的 OS 和 PFS 无显著差异，但 IC/CCRT 组的副作用更多。
