调强放疗中颈 Ib 区预防性照射与 Ib 区放疗在高危鼻咽癌治疗中的比较：一项倾向评分匹配队列研究。
Neck level Ib-sparing versus level Ib-irradiation in intensity-modulated radiotherapy for the treatment of nasopharyngeal carcinoma with high-risk factors: A propensity score-matched cohort study.
机构信息
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Center for Precision Medicine of Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Center for Precision Medicine of Sun Yat-sen University, Guangzhou, People's Republic of China.
出版信息
Radiother Oncol. 2022 Dec;177:205-213. doi: 10.1016/j.radonc.2022.11.005. Epub 2022 Nov 11.
AIM
Level Ib lymph nodes metastasis is rare in nasopharyngeal carcinoma (NPC). We aimed to evaluate the feasibility of sparing level Ib-irradiation in NPC patients with high-risk factors.
MATERIALS AND METHODS
Four hundred forty-three NPC patients with radiologic extranodal extension (rENE) or level II lymph node maximal axial diameter (MAD) ≥ 20 mm treated by intensity-modulated radiotherapy (IMRT) between 2009 and 2012 were included in this study. Propensity score matching (PSM) was applied to balance potential prognostic factors (including age, sex, T and N stage, pretreatment EBV DNA level, and level II rENE and MAD) between patients who received and omitted level Ib irradiation. Kaplan-Meier analysis and the log-rank test were used to compare regional survival outcomes.
RESULTS
PSM resulted in 169 matched pairs of eligible patients. The median follow-up period was 119 months in the matched cohort. The number of level Ib failure in the level Ib-sparing and level-Ib irradiation groups were 3/169 (1.8 %) vs 2/169 (1.2 %), P > 0.999. And the 5-year regional relapse-free survival (RRFS) rates of the two groups were 88.4 % vs 92.6 %, respectively. After PSM, RRFS (hazard ratio [HR]: 1.508, 95 % confidence interval [CI]: 0.762-2.986, P = 0.239), OS (HR: 1.219, 95 % CI: 0.754-1.972, P = 0.418), distant metastasis-free survival (DMFS) (HR: 1.605, 95 % CI: 0.900-2.863, P = 0.109), and local relapse-free (LRFS) (HR: 0.956, 95 % CI: 0.436-2.095, P = 0.910) were similar in the two arms. The incidence of grade ≥ 1 dry mouth after 5 years was higher in the level Ib-irradiation group (27.5 % vs 16.5 %, P = 0.029). However, the incidences of grade 3-4 late toxicities were similar between the two groups.
CONCLUSION
Neck level Ib-sparing appears to be safe and feasible in NPC patients with rENE or level II MAD ≥ 20 mm and negative level Ib lymph nodes. Compared with cervical level Ib-irradiation, omission of irradiation to level Ib provides less dry mouth symptom.
目的
颈淋巴结区 Ib 转移在鼻咽癌（NPC）中罕见。本研究旨在评估对具有高危因素的 NPC 患者行 Ib 区淋巴结区免于放疗的可行性。
材料与方法
本研究纳入了 443 例 2009 年至 2012 年接受调强放疗（IMRT）治疗的影像学存在结外侵犯（rENE）或 II 区淋巴结最大轴向直径（MAD）≥20mm的 NPC 患者。采用倾向评分匹配（PSM）来平衡两组患者（包括年龄、性别、T 和 N 分期、治疗前 EBV DNA 水平和 II 区 rENE 和 MAD）之间潜在的预后因素。采用 Kaplan-Meier 分析和对数秩检验比较两组患者的区域生存结局。
结果
PSM 后共纳入 169 对匹配的合格患者。在匹配队列中，中位随访时间为 119 个月。在 Ib 区免于放疗组和 Ib 区放疗组中，Ib 区失败的患者分别为 3/169（1.8%）和 2/169（1.2%），P>0.999。两组患者的 5 年区域无复发生存率（RRFS）分别为 88.4%和 92.6%。PSM 后，RRFS（风险比 [HR]：1.508，95%置信区间 [CI]：0.762-2.986，P=0.239）、总生存（OS）（HR：1.219，95%CI：0.754-1.972，P=0.418）、无远处转移生存（DMFS）（HR：1.605，95%CI：0.900-2.863，P=0.109）和无局部复发生存（LRFS）（HR：0.956，95%CI：0.436-2.095，P=0.910）在两组间无显著差异。5 年后，Ib 区放疗组中出现≥1 级口干的患者比例较高（27.5% vs 16.5%，P=0.029）。然而，两组间 3-4 级晚期毒性的发生率相似。
结论
对于存在 rENE 或 II 区 MAD≥20mm 且 Ib 区淋巴结阴性的 NPC 患者，颈部 Ib 区淋巴结区免于放疗是安全可行的。与颈部 Ib 区放疗相比，Ib 区免于放疗可减轻口干症状。
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