State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; Department of Oncology, Ganzhou People's Hospital, Ganzhou, Jiangxi, P. R. China.
Int J Radiat Oncol Biol Phys. 2019 Jan 1;103(1):45-51. doi: 10.1016/j.ijrobp.2018.09.015. Epub 2018 Sep 20.
The objective of this study was to reveal the long-term sequelae in survivors of childhood and adolescent nasopharyngeal carcinoma after radiation therapy.
We reviewed the medical records of patients aged <18 years with nasopharyngeal carcinoma who were treated at Sun Yat-sen University Cancer Center from February 1991 to October 2010. Data concerning clinical characteristics, treatment, outcomes, and late morbidities were extracted. We used χ tests and binary regression analysis to compare the cumulative incidence (CI) of treatment comorbidities among different groups of survivors.
A total of 94 patients survived. They had a median follow-up time of 10 years (5-27 years). Compared with the CI of survivors treated with conventional radiation therapy treatment, the CI of xerostomia, dysphagia, and chronic otitis media was significantly decreased in the survivors treated with intensity modulated radiation therapy treatment. The CI of blurred vision in patients younger than 10 years and in patients 10 to 18 years old were 33.3% and 2.3%, respectively (P = .006). Survivors who received a nasopharynx dose >72 Gy, compared with a nasopharynx dose of 60 to 72 Gy, had a significantly higher CI of hearing loss (P = .008), lalopathy (P = .013), and cranial nerve injury (P = .029). We also had records of height, weight, education level, annual income, marital and fertility status, and menstruation state for 59 of the survivors. Twenty-two percent of the survivors had a body mass index lower than 18.5. Among the female survivors, 11 of 16 (62.5%) had menstrual or fertility problems.
Compared with convention radiation therapy treatment, intensity modulated radiation therapy treatment can potentially ameliorate xerostomia, dysphagia, and chronic otitis media. In addition, patients younger than 10 years had a higher CI of blurred vision. Moreover, a dose of more than 72 Gy to primary tumor increased the CI of hearing loss, lalopathy, and cranial nerve injury.
本研究旨在揭示接受放射治疗的儿童和青少年鼻咽癌幸存者的长期后遗症。
我们回顾了中山大学肿瘤中心 1991 年 2 月至 2010 年 10 月期间治疗的年龄<18 岁的鼻咽癌患者的病历。提取了有关临床特征、治疗、结局和晚期并发症的数据。我们使用 χ 检验和二元回归分析比较了不同幸存者组治疗合并症的累积发生率（CI）。
共有 94 例患者存活。他们的中位随访时间为 10 年（5-27 年）。与接受常规放射治疗的幸存者的口干、吞咽困难和慢性中耳炎的 CI 相比，接受调强放射治疗的幸存者的口干、吞咽困难和慢性中耳炎的 CI 显著降低。10 岁以下和 10-18 岁患者视力模糊的 CI 分别为 33.3%和 2.3%（P=.006）。与接受 60-72Gy 鼻咽剂量的幸存者相比，接受>72Gy 鼻咽剂量的幸存者听力损失（P=.008）、喉病变（P=.013）和颅神经损伤（P=.029）的 CI 明显更高。我们还为 59 名幸存者记录了身高、体重、教育程度、年收入、婚姻和生育状况以及月经状况。22%的幸存者体重指数低于 18.5。在女性幸存者中，16 人中有 11 人（62.5%）有月经或生育问题。
与常规放射治疗相比，调强放射治疗可能改善口干、吞咽困难和慢性中耳炎。此外，10 岁以下的患者视力模糊的 CI 更高。此外，原发肿瘤剂量>72Gy 会增加听力损失、喉病变和颅神经损伤的 CI。
