Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Shanghai, China.
Cancer Med. 2018 Dec;7(12):6010-6019. doi: 10.1002/cam4.1866. Epub 2018 Nov 8.
To observe the local regression and control in T1-2 nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) and to analyze the related influencing factors.
Between January 2006 and June 2014, 247 consecutive T1-2 NPC patients treated with IMRT were retrospectively analyzed, with 126 (51.0%) N0-1 disease and 121 (49.0%) N2-3 disease. Among them, 72.9% received platinum-based chemotherapy. The prescribed dose to gross tumor volume was 66 Gy/30 fractions.
By the end of IMRT, the chemoradiotherapy (CRT) group had higher local complete response (CR) rate compared with IMRT alone group (92.2% vs 74.6%, P < 0.001), but no significant difference was discovered in 5-year local control (LC) rate (95.1% vs 94.9%, P = 0.968). Of the rest 31 patients with residual nasopharyngeal lesions after IMRT, those received boost irradiation (67.7%) also showed no improvement in 5-year LC rate compared with the observational group (95.0% vs 100.0%, P = 0.307). With a median follow-up of 63 months, the estimated 5-year LC rate for the whole group was 95.1% (T1 vs T2: 95.9% vs 94.7%, P = 0.186). Prognostic factors for LC were found neither in univariate nor in multivariate analysis. Advanced N stage was found to be the only adverse prognostic factor for all the other survivals.
Excellent LC could be achieved in T1-2 NPC treated with IMRT. The addition of chemotherapy may offer short-term response benefit, but no significant LC benefit, so did boost irradiation. Attention should be attached to advanced N stage, the exploration of the recurrence-related factors, and the necessities of the additional treatment.
观察调强放疗（IMRT）治疗 T1-2 期鼻咽癌（NPC）患者的局部回归和控制情况，并分析相关影响因素。
回顾性分析 2006 年 1 月至 2014 年 6 月期间 247 例接受 IMRT 治疗的 T1-2 NPC 患者，其中 N0-1 期疾病 126 例（51.0%），N2-3 期疾病 121 例（49.0%）。其中 72.9%的患者接受了铂类为基础的化疗。大体肿瘤体积的规定剂量为 66Gy/30 次。
在 IMRT 结束时，放化疗组的完全缓解（CR）率高于单纯 IMRT 组（92.2% vs 74.6%，P<0.001），但 5 年局部控制率（LC）无显著差异（95.1% vs 94.9%，P=0.968）。在 IMRT 后仍有残留鼻咽病变的 31 例患者中，接受推量照射的患者（67.7%）5 年 LC 率也无改善（观察组为 95.0%，对照组为 100.0%，P=0.307）。中位随访 63 个月时，全组 5 年 LC 率为 95.1%（T1 期 vs T2 期：95.9% vs 94.7%，P=0.186）。单因素和多因素分析均未发现 LC 的预后因素。晚期 N 期是所有其他生存结果的唯一不良预后因素。
IMRT 治疗 T1-2 NPC 可获得良好的 LC。化疗的加入可能会带来短期的反应获益，但对 LC 没有显著获益，推量照射也是如此。应注意晚期 N 期，探索与复发相关的因素，以及是否需要额外的治疗。
