Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong, China.
Head Neck. 2021 Jun;43(6):1711-1720. doi: 10.1002/hed.26634. Epub 2021 Feb 11.
BACKGROUND: The durability of improved xerostomia with intensity-modulated radiotherapy (IMRT) in patients with early stage nasopharyngeal carcinoma (NPC) is uncertain. We conducted a long-term prospective assessment of participants treated with IMRT or two-dimensional radiotherapy (2DRT) in a prior randomized study. METHODS: Parent study participants (IMRT, n = 28; 2DRT, n = 28) who were free of second malignancy or recurrence were eligible. Long-term radiotherapy-related toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) criteria. Long-term patient-reported outcomes were assessed by the six-item xerostomia (XQ) and two European Organisation for Research and Treatment of Cancer (EORTC) questionnaires (QLQ-C30, QLQ-H&N35). Overall survival (OS), locoregional relapse-free survival (LRFS), distant relapse-free survival (DRFS), and the rate of symptomatic late complications (SLCs) were estimated for the entire cohort (n = 56). RESULTS: Totally, 21 (IMRT, n = 10; 2DRT, n = 11) patients gave consent and were assessed for an overall median follow-up of 15.5 years. There was significantly less RTOG ≥grade 2 xerostomia with IMRT versus 2DRT (20% vs. 90%; p = 0.001), but no significant difference in XQ scores. Patients in the IMRT arm reported lower mean scores for the "dry mouth" domain of EORTC QLQ-H&N35 (p = 0.02) and showed trends toward better 15-year OS (81.5% vs. 53.8%, p = 0.06), LRFS (70.6% vs. 53.8%, p = 0.38), and DRFS (81.5% vs. 53.8%, p = 0.07). SLCs were more frequent in the 2DRT arm. CONCLUSIONS: The parotid-sparing effect of IMRT in NPC treatment is durable, with significantly less physician- and patient-scored xerostomia at 15 years. IMRT results in better long-term survival and fewer SLCs.
背景：调强放疗（IMRT）治疗早期鼻咽癌（NPC）患者的口干持久性尚不确定。我们对先前随机研究中接受 IMRT 或二维放疗（2DRT）治疗的参与者进行了长期前瞻性评估。 方法：符合条件的参与者为无第二恶性肿瘤或复发的原研究参与者（IMRT，n=28；2DRT，n=28）。根据放射治疗肿瘤学组（RTOG）标准对长期放疗相关毒性进行分级。通过六项口干症（XQ）和两个欧洲癌症研究与治疗组织（EORTC）问卷（QLQ-C30、QLQ-H&N35）评估长期患者报告结局。对整个队列（n=56）的总生存期（OS）、局部区域无复发生存率（LRFS）、远处无复发生存率（DRFS）和症状性晚期并发症（SLC）发生率进行了估计。 结果：共有 21 名（IMRT，n=10；2DRT，n=11）患者同意并接受评估，中位随访时间为 15.5 年。与 2DRT 相比，IMRT 的 RTOG 口干症≥2 级的比例显著较低（20% vs. 90%；p=0.001），但 XQ 评分无显著差异。IMRT 组患者 EORTC QLQ-H&N35 中“口干”域的平均评分较低（p=0.02），15 年 OS（81.5% vs. 53.8%，p=0.06）、LRFS（70.6% vs. 53.8%，p=0.38）和 DRFS（81.5% vs. 53.8%，p=0.07）的趋势较好。2DRT 组 SLC 更为频繁。 结论：NPC 治疗中 IMRT 的腮腺保护作用持久，15 年后医生和患者的口干评分明显降低。IMRT 可带来更好的长期生存和更少的 SLC。
J Cancer Res Clin Oncol. 2019-11-1
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