Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
Int J Radiat Oncol Biol Phys. 2023 Jul 15;116(4):788-796. doi: 10.1016/j.ijrobp.2022.12.041. Epub 2022 Dec 31.
Upper-neck irradiation (UNI) at the uninvolved neck has shown similar regional relapse-free survival as standard whole-neck irradiation (WNI) in patients with N0-1 nasopharyngeal carcinoma. However, whether UNI at the contralateral uninvolved neck is feasible in unilateral N3 disease, defined as >6 cm and/or below the caudal border of the cricoid cartilage, remains unclear.
Data for 291 patients with nasopharyngeal carcinoma with unilateral N3 disease who were treated with intensity modulated radiation therapy from 2009 to 2015 were retrospectively analyzed. Among them, 190 received bilateral WNI (WNI group); the remaining 101 received WNI at the involved neck and UNI at the contralateral uninvolved neck (UNI group). Survival rates were estimated using the Kaplan-Meier method, and differences between groups were compared using the log rank tests.
The median follow-up was 79.4 months (interquartile range, 56.0-89.3). Twenty-five patients had regional lymph node relapses (UNI: 10.9%, 11/101 vs WNI: 7.4%, 14/190; P = .31). Of these, 23 patients relapsed within the previously involved neck regions, while only 2 patients had relapses in the contralateral uninvolved neck (1 each in the UNI and WNI groups). Five-year regional relapse-free survival rates were similar between groups (89.7% vs 92.7%, P = .29). Similar between-group findings were also observed for 5-year overall survival (76.1% vs 80.4%, P = .40), distant metastasis-free survival (74.9% vs 79.2%, P = .44), and local relapse-free survival (95.6% vs 94.7%, P = .64). Furthermore, oncologic outcomes in subgroup and multivariable analyses were similar between groups.
Regional control and survival outcomes were comparable in UNI at the contralateral uninvolved neck and standard WNI in patients with nasopharyngeal carcinoma with unilateral N3 disease. Our findings provide evidence for future radiation therapy guidelines of nasopharyngeal carcinoma.
在未受累颈部进行上颈部照射（UNI）在 N0-1 期鼻咽癌患者中的局部无复发生存率与标准全颈照射（WNI）相似。然而，在单侧 N3 疾病（定义为>6cm 和/或环状软骨下缘以下）中，对对侧未受累颈部进行 UNI 是否可行尚不清楚。
回顾性分析了 2009 年至 2015 年接受调强放疗的 291 例单侧 N3 疾病鼻咽癌患者的数据。其中，190 例接受双侧 WNI（WNI 组）；其余 101 例接受受累颈部的 WNI 和对侧未受累颈部的 UNI（UNI 组）。使用 Kaplan-Meier 法估计生存率，并用对数秩检验比较组间差异。
中位随访时间为 79.4 个月（四分位距，56.0-89.3）。25 例患者出现区域淋巴结复发（UNI：10.9%，11/101；与 WNI：7.4%，14/190；P=.31）。其中 23 例复发于先前受累的颈部区域，而仅有 2 例患者在对侧未受累颈部复发（UNI 和 WNI 组各 1 例）。两组 5 年区域无复发生存率相似（89.7% vs 92.7%，P=.29）。两组 5 年总生存率（76.1% vs 80.4%，P=.40）、无远处转移生存率（74.9% vs 79.2%，P=.44）和局部无复发生存率（95.6% vs 94.7%，P=.64）也相似。此外，亚组和多变量分析的肿瘤学结果在两组之间相似。
在单侧 N3 疾病鼻咽癌患者中，对侧未受累颈部的 UNI 与标准 WNI 的局部控制和生存结果相当。我们的研究结果为鼻咽癌放疗指南提供了依据。
