Radiotherapy department, Centre Oscar Lambret, Lille, France.
Radiotherapy department, Institut Curie, Paris, France.
Strahlenther Onkol. 2019 Jun;195(6):504-516. doi: 10.1007/s00066-019-01461-6. Epub 2019 Apr 8.
The aim of this study was to retrospectively study survival and long-term morbidities of children with nasopharyngeal carcinoma (NPC) treated by induction chemotherapy and concurrent chemoradiation (CRT). The total dose of radiation was adapted to the response following neoadjuvant chemotherapy.
Children with non-metastatic NPC treated in France between 1999 and 2015 were retrospectively included in the study. The strategy combined neoadjuvant platinum-based chemotherapy, followed by adapted CRT to tumor response.
In total, 95 patients (median age 15 years [range, 7-23 years], male-to-female ratio 1.8) with undifferentiated NPC were included; 59% of patients had TNM stage IV. Intensity-modulated radiotherapy (IMRT) was delivered to 57 patients (60%), while the other patients were treated with conformal RT (3D-RT). After a median follow-up of 4.5 years [range, 3.6-5.5 years], 13 relapses and seven deaths had occurred. The 3‑year overall and relapse-free survival (RFS) were 94% [95% CI, 85-97%] and 86% [77-92%], respectively. The locoregional failure rate was 6% [95% CI, 2-14]. Long-term treatment-related sequelae of grade 2+ were reported by 37 (50%) patients; odynophagia was significantly reduced treated by IMRT vs. conventional 3D-RT (7% vs. 55%, p = 0.015). Using a reduction dose of 59.4 Gy, 54 Gy, and 45 Gy, respectively, to the primary, involved, and uninvolved neck nodes, after a favorable tumor response, was not associated with an increased locoregional failure rate.
The survival rates for NPC have been considerably improved by means of multimodal therapy, but long-term locoregional morbidity remains common. Use of IMRT may induce less residual odynophagia. Radiation dose reduction adapted to chemotherapy response does not have a negative impact on outcome. These findings support the use of an RT protocol adapted to the tumor response to neoadjuvant chemotherapy for a long-lasting improvement in the patient's quality of life.
本研究旨在回顾性研究诱导化疗和同期放化疗（CRT）治疗儿童鼻咽癌（NPC）的生存和长期并发症。放射总剂量根据新辅助化疗的反应进行调整。
本研究回顾性纳入 1999 年至 2015 年在法国接受治疗的非转移性 NPC 患儿。该策略联合新辅助铂类化疗，然后根据肿瘤反应调整 CRT。
共纳入 95 例未分化 NPC 患儿（中位年龄 15 岁[范围：7-23 岁]，男女性别比 1.8）；59%的患者为 IV 期。57 例患者（60%）接受调强放疗（IMRT），其余患者接受适形放疗（3D-RT）。中位随访 4.5 年[范围：3.6-5.5 年]后，13 例复发，7 例死亡。3 年总生存率和无复发生存率（RFS）分别为 94%[95%CI：85-97%]和 86%[77-92%]。局部区域失败率为 6%[95%CI：2-14%]。37 例（50%）患者报告有 2+级以上的长期治疗相关后遗症；与常规 3D-RT 相比，IMRT 治疗后吞咽困难明显减少（7%比 55%，p=0.015）。在肿瘤反应良好的情况下，分别采用 59.4Gy、54Gy 和 45Gy 对原发、累及和未累及颈部淋巴结进行减剂量照射，并未导致局部区域失败率增加。
多模式治疗显著提高了 NPC 的生存率，但长期局部区域发病率仍然较高。使用调强放疗可能会减少残留的吞咽困难。根据化疗反应调整放射剂量不会对结果产生负面影响。这些发现支持使用适应新辅助化疗肿瘤反应的放疗方案，以长期改善患者的生活质量。
