The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China.
Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Hangzhou, 310022, China.
Radiat Oncol. 2022 Nov 7;17(1):176. doi: 10.1186/s13014-022-02147-7.
To assess the effectiveness and toxicity of radiation dose escalation for locally advanced nasopharyngeal carcinoma (LA-NPC) in patients with local and/or regional residual lesion(s) after standard treatment.
From November 2011 to November 2020, 259 LA-NPC patients who had local and/or regional residual lesion(s) after induction chemotherapy followed by concurrent chemoradiotherapy (IC + CCRT) from our hospital were included. The total dose of primary radiotherapy (RT) was 68.1-74.25 Gy (median, 70.4 Gy). The boost doses were 4.0-18.0 Gy (median, 9 Gy), 1.8-2.0 Gy/fraction.
For all patients, the 5-year local relapse-free survival was 90.2%, regional relapse-free survival was 89.1%, locoregional relapse-free survival (LRRFS) was 79.5%, distant metastasis-free survival (DMFS) was 87.9%, failure-free survival (FFS) was 69.0%, and overall survival (OS) was 86.3%. LRRFS, DMFS, FFS, and OS in patients with age ≤ 65 versus > 65, plasma Epstein-Barr virus-deoxyribonucleic acid ≤ 500 versus > 500, T versus T, N versus N, and stage III versus stage IV showed no statistically significant differences. The interval between primary RT and boost was not a prognostic factor for LRRFS, DMFS, FFS, and OS. Males had a lower 3-year FFS rate than females (72.9% vs. 83.7%, P = 0.024). LA-NPCs with locally and regionally residual lesion(s) had the worst 3-year DMFS and OS rates compared with locally or regionally residual lesion(s) (77.7% vs. 98.8% vs. 87.4%, P = 0.014; 75.9% vs. 94.5% vs. 82.4%, P = 0.002).
Boost radiation was an option for LA-NPCs with locally and/or regionally residual lesions after receiving IC + CCRT. It warrants further prospective study.
Retrospectively registered.
评估局部晚期鼻咽癌（LA-NPC）患者在标准治疗后局部和/或区域残留病灶（s）接受辐射剂量递增的有效性和毒性。
从 2011 年 11 月至 2020 年 11 月，我院收治了 259 例局部晚期 NPC 患者，这些患者在诱导化疗后局部和/或区域有残留病灶（s），并接受同期放化疗（IC+CCRT）。原发放疗（RT）的总剂量为 68.1-74.25Gy（中位数为 70.4Gy）。推量剂量为 4.0-18.0Gy（中位数为 9Gy），1.8-2.0Gy/分次。
所有患者的 5 年局部无复发生存率为 90.2%，区域无复发生存率为 89.1%，局部区域无复发生存率（LRRFS）为 79.5%，无远处转移生存率（DMFS）为 87.9%，无失败生存率（FFS）为 69.0%，总生存率（OS）为 86.3%。年龄≤65 岁与>65 岁、血浆 Epstein-Barr 病毒脱氧核糖核酸≤500 与>500、T 期与 T 期、N 期与 N 期、III 期与 IV 期患者的 LRRFS、DMFS、FFS 和 OS 无统计学差异。原发 RT 与推量的间隔不是 LRRFS、DMFS、FFS 和 OS 的预后因素。男性 3 年 FFS 率低于女性（72.9% vs. 83.7%，P=0.024）。与局部或区域残留病灶相比，局部和区域残留病灶的 LA-NPCs 3 年 DMFS 和 OS 最差（77.7% vs. 98.8% vs. 87.4%，P=0.014；75.9% vs. 94.5% vs. 82.4%，P=0.002）。
对于接受 IC+CCRT 治疗后局部和/或区域有残留病灶的 LA-NPC 患者，推量放疗是一种选择。需要进一步的前瞻性研究。
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