Netto Eduardo, Ferreira Margarida, Esteves Susana, Sargento Isabel, Alexandre Teresa, Pocinho Rute, Mota Antonio, Labareda Miguel, Rito Miguel, Cabeçadas José, Magalhães Miguel, Roldão Margarida
Radiation Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.
Rep Pract Oncol Radiother. 2020 Jul-Aug;25(4):521-526. doi: 10.1016/j.rpor.2020.04.012. Epub 2020 Apr 28.
Report our matured outcomes of European nasopharyngeal carcinoma (NPC) treatment from a non-endemic region in the IMRT era.
We reviewed 109 consecutive patients with biopsy proven NPC treated between 2009 and 2013. All received IMRT as per RTOG 0615. Toxicity was scored accordingly to CTCAE 4.03. Platinum-based chemotherapy was delivered following the Intergroup 0099.
Median age of 53 years; 97% Caucasian; 74% male; 72% WHO grade III; 43% T1; 14% T2; 18% T3, 25% T4; 17% N0; 17% N1; 39% N2; 27% N3. Compliance to adjuvant chemotherapy was 88%. With a median follow up of 56 months, the 4-year local control was 90.2% (88.6% for T1; 100% for T2; 85% for T3; and 91.7% for T4), the 4-year distant metastases-free survival was 86% and an overall survival rate was 77%. Local control and survival were better in G3 (p < 0.001 and p = 0.032, respectively). Xerostomia was the most frequent late toxicity in 55% (n = 60). Hypothyroidism requiring hormonal reposition occurred in 15.5% (n = 17). From the 36 deaths, 20 were due to distant metastases, 3 grade 5 toxicity, 2 from local progression, 5 non-cancer deaths and unknown cause in the remaining 6. On multivariable analysis, age (p = 0.017), local recurrence and distant metastases were associated with death (p < 0.001, both).
Our matured data from the IMRT era showed a major improvement from our 3D cohort series reaching excellent local and regional control, even in T4. Local recurrences, despite few, and distant metastases were correlated with the risk of death.
报告在调强放疗（IMRT）时代，我们来自非鼻咽癌（NPC）流行地区的欧洲NPC治疗的成熟结果。
我们回顾了2009年至2013年间连续治疗的109例经活检证实为NPC的患者。所有患者均按照美国放射肿瘤学组（RTOG）0615方案接受IMRT治疗。毒性根据美国国立癌症研究所（NCI）的不良事件通用术语标准（CTCAE）4.03进行评分。铂类化疗按照国际协作组0099方案进行。
中位年龄53岁；97%为白种人；74%为男性；72%为世界卫生组织（WHO）III级；43%为T1期；14%为T2期；18%为T3期，25%为T4期；17%为N0期；17%为N1期；39%为N2期；27%为N3期。辅助化疗的依从率为88%。中位随访56个月，4年局部控制率为90.2%（T1期为88.6%；T2期为100%；T3期为85%；T4期为91.7%），4年无远处转移生存率为86%，总生存率为77%。G3级患者的局部控制和生存率更好（分别为p < 0.001和p = 0.032）。口干是最常见的晚期毒性反应，发生率为55%（n = 60）。需要激素替代治疗的甲状腺功能减退发生率为15.5%（n = 17）。在36例死亡病例中，20例死于远处转移，3例死于5级毒性反应，2例死于局部进展，5例死于非癌症死亡，其余6例死因不明。多变量分析显示，年龄（p = 0.017）、局部复发和远处转移与死亡相关（两者p均< 0.001）。
我们在IMRT时代的成熟数据显示，与我们的三维队列系列相比有了重大改善，即使在T4期也能达到出色的局部和区域控制。局部复发虽少，但远处转移与死亡风险相关。
