ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
Department of Radiation Oncology, Eye and ENT Hospital of Fudan University, Shanghai, China.
Int Forum Allergy Rhinol. 2023 Feb;13(2):140-150. doi: 10.1002/alr.23051. Epub 2022 Jul 21.
The choice between endoscopic surgery and re-radiotherapy as the main treatment modality in patients with advanced recurrent nasopharyngeal carcinoma (rNPC) remains controversial. Therefore, in this study, we compared the efficacies of endoscopic surgery and intensity-modulated radiotherapy (IMRT) in patients with rNPC.
All patients with advanced rNPC (T3 and T4) who underwent salvage treatment were enrolled from January 2009 to December 2020. Overall survival (OS) was analyzed using a log-rank analysis. Univariate and multivariate analyses of OS were performed using a Cox regression model. Common treatment-related complications of endoscopic surgery were compared with those of IMRT.
The numbers of patients with T3 and T4 tumors were 163 (64.2%) and 91 (35.8%), respectively; 192 patients underwent endoscopic surgery, 51 received IMRT, and 11 received three-dimensional conformal radiotherapy (3D-CRT). The 3-year OS of patients treated with endoscopic surgery was 59.3%, which was significantly higher than that of patients treated with IMRT (34.7%, p < 0.001) or 3D-CRT (43.6%, p = 0.012). Multivariate analyses showed that IMRT was an independent risk factor for OS compared with endoscopic surgery (hazard ratio, 2.068; 95% confidence interval, 1.395-3.069, p < 0.001). Complications of aural fullness (p = 0.001), nasopharyngeal necrosis (p = 0.004), nasopharyngeal hemorrhage (p = 0.004), dysphagia (p < 0.001), and cerebral infarction (p = 0.030) were significantly lower in the endoscopic surgery group than in the IMRT group.
Endoscopic surgery may be a more promising salvage treatment than IMRT to maximize survival and minimize treatment-related complications in advanced rNPC. These results will be significant in deciding the optimal treatment for patients with advanced rNPC.
在晚期复发鼻咽癌（rNPC）患者中，内镜手术与再放疗作为主要治疗方式的选择仍存在争议。因此，本研究比较了内镜手术和调强放疗（IMRT）在 rNPC 患者中的疗效。
2009 年 1 月至 2020 年 12 月，我们收治了所有接受挽救性治疗的晚期 rNPC（T3 和 T4）患者。采用对数秩分析比较患者的总生存期（OS）。采用 Cox 回归模型进行 OS 的单因素和多因素分析。比较内镜手术与 IMRT 常见的治疗相关并发症。
T3 和 T4 肿瘤患者分别为 163 例（64.2%）和 91 例（35.8%）；192 例患者接受内镜手术治疗，51 例接受 IMRT 治疗，11 例接受三维适形放疗（3D-CRT）。内镜手术治疗患者的 3 年 OS 为 59.3%，显著高于 IMRT（34.7%，p<0.001）或 3D-CRT（43.6%，p=0.012）治疗患者。多因素分析显示，与内镜手术相比，IMRT 是 OS 的独立危险因素（风险比 2.068；95%置信区间 1.395-3.069，p<0.001）。中耳饱满感（p=0.001）、鼻咽坏死（p=0.004）、鼻咽出血（p=0.004）、吞咽困难（p<0.001）和脑梗死（p=0.030）并发症发生率在内镜手术组显著低于 IMRT 组。
与 IMRT 相比，内镜手术可能是晚期 rNPC 患者提高生存率和减少治疗相关并发症的更有前途的挽救性治疗方法。这些结果对于决定晚期 rNPC 患者的最佳治疗方案具有重要意义。
