Shim Hyun Jeong, Kim Hyeon Jong, Hwang Jun Eul, Bae Woo Kyun, Chung Ik Joo, Lee Dong Hoon, Mi Yoon Tae, Lee Joon Kyoo, Lim Sang Chul, Chung Jae Wook, Cho Sang Hee
Department of Hematology and Oncology.
Otorhinolaryngology-Head and Neck Surgery.
Medicine (Baltimore). 2020 Dec 4;99(49):e23173. doi: 10.1097/MD.0000000000023173.
This study was conducted to evaluate the long term complications and their risk factors including of survival outcomes in patients with locally advanced nasopharyngeal cancer (NPC) treated with docetaxel, cisplatin and 5-fluorouracil (TPF) induction chemotherapy followed by concurrent chemoradiotherapy (CCRT).Among the patients who were diagnosed as NPC, we consecutively evaluated the late complications in 104 patients who completed 3 cycles of TPF induction chemotherapy followed by CCRT and received regular follow-up by otolaryngologist and oncologist. The prognostic factors for overall survival, relapse free survival and each complication were analyzed based on clinical characteristics.Over a median follow-up of 54 months (range, 7.9-152.9 months), 5-year overall survival rate was 87% for stage II, 89% for stage III, 87% for stage IV patients. The significant prognostic factor for survival is complete response rate after CCRT in multivariate analysis. The most frequent toxicity was ear complication (29.8%) including of hearing loss requiring hearing aid (6.7%) and bone necrosis (3.8%). Decreased renal function over grade 2 was occurred in only 4 patients (3.8%) regardless of the cumulative dose of cisplatin. The long term complications did not affect the survival outcome. Patients who received radiation therapy more than 5400 cGy had better survival outcome than those who did not. However, ear complication was significantly related to radiation dose (≥ 6,600 cGy) and type of radiation therapy (conventional). Age over 65 years was a significant risk factor for both ear and renal toxicity. In conclusion, close follow-up to monitor long-term complications should be performed in patients treated with TPF induction chemotherapy followed by CCRT treatment, especially in elderly patients. Reestablishing the optimal chemotherapeutic agent during CCRT and adjustment of radiation dose after induction chemotherapy could be helpful to reduce the toxicity associated with the subsequent treatment strategy for locally advance NPC patients.
本研究旨在评估多西他赛、顺铂和5-氟尿嘧啶（TPF）诱导化疗后序贯同步放化疗（CCRT）治疗局部晚期鼻咽癌（NPC）患者的长期并发症及其危险因素，包括生存结局。在确诊为NPC的患者中，我们连续评估了104例完成3周期TPF诱导化疗后序贯CCRT并接受耳鼻喉科医生和肿瘤内科医生定期随访的患者的晚期并发症。根据临床特征分析总生存、无复发生存和每种并发症的预后因素。中位随访54个月（范围7.9 - 152.9个月），II期患者5年总生存率为87%，III期为89%，IV期为87%。多因素分析显示，CCRT后完全缓解率是生存的显著预后因素。最常见的毒性反应是耳部并发症（29.8%），包括需要佩戴助听器的听力损失（6.7%）和骨坏死（3.8%）。无论顺铂累积剂量如何，仅4例患者（3.8%）出现2级以上肾功能下降。长期并发症未影响生存结局。接受超过5400 cGy放疗的患者比未接受者生存结局更好。然而，耳部并发症与放疗剂量（≥6600 cGy）和放疗类型（传统放疗）显著相关。65岁以上是耳部和肾脏毒性的显著危险因素。总之，对于接受TPF诱导化疗后序贯CCRT治疗的患者，尤其是老年患者，应密切随访以监测长期并发症。在CCRT期间重新确定最佳化疗药物并在诱导化疗后调整放疗剂量可能有助于降低局部晚期NPC患者后续治疗策略相关的毒性。
