Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
Oral Oncol. 2019 Feb;89:102-106. doi: 10.1016/j.oraloncology.2018.12.028. Epub 2018 Dec 31.
Definitive concurrent chemoradiotherapy (CCRT) is the standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC). The cumulative cisplatin dose (CCD) during radiotherapy is an important prognostic factor; however, the optimal CCD is undetermined.
In this retrospective analysis, patients with locoregionally advanced NPC treated with single-agent cisplatin-based CCRT or RT alone from 2009 through 2015 were identified. CCD was entered into a multivariate Cox regression model as a continuous variable using natural cubic splines to allow for a nonlinear relationship between CCD and outcomes. The primary endpoint was overall survival, and the secondary endpoints were locoregional relapse-free survival and distant metastasis-free survival.
A total of 2 924 patients were included in our study, with a median CCD of 160 mg/m (range, 0-300 mg/m). As the CCD increased, the risk of death remained steady until 180 mg/m, then decreased sharply until 250 mg/m, and then increased until 300 mg/m. The optimal CCD of 230-270 mg/m was associated with the lowest risk of death and disease relapse. However, the CCD had less prognostic value for disease control, especially for distant control among high-risk patients (N2-3 or T4).
A CCD dose of 230-270 mg/m (240 mg/m is recommended) is optimal for patients with locoregionally advanced NPC, especially for those at low risk (T1-3 and N0-1). For high-risk patients (N2-3 or T4), additional chemotherapy should be administered before or after CCRT.
根治性同期放化疗（CCRT）是局部晚期鼻咽癌（NPC）的标准治疗方法。放疗期间累积顺铂剂量（CCD）是一个重要的预后因素，但最佳 CCD 尚未确定。
本回顾性分析纳入了 2009 年至 2015 年期间接受单药顺铂为基础的 CCRT 或单纯放疗的局部晚期 NPC 患者。CCD 作为连续变量输入多变量 Cox 回归模型，采用自然三次样条允许 CCD 与结局之间存在非线性关系。主要终点为总生存，次要终点为局部无复发生存和无远处转移生存。
共纳入 2924 例患者，中位 CCD 为 160mg/m（范围，0-300mg/m）。随着 CCD 的增加，死亡风险保持稳定，直到 180mg/m，然后急剧下降，直到 250mg/m，然后再次增加，直到 300mg/m。最佳 CCD 为 230-270mg/m 与死亡和疾病复发风险最低相关。然而，CCD 对疾病控制的预后价值较低，尤其是对高危患者（N2-3 或 T4）的远处控制。
局部晚期 NPC 患者的 CCD 剂量为 230-270mg/m（推荐剂量为 240mg/m）是最佳的，尤其是低危患者（T1-3 和 N0-1）。对于高危患者（N2-3 或 T4），在 CCRT 之前或之后应给予额外化疗。
