Meng Lingling, Teng Feng, Liu Qiteng, Du Lei, Cai Boning, Xie Chuanbin, Gong Hanshun, Zhang Xinxin, Ma Lin
Medical School of the Chinese People's Liberation Army (PLA), Beijing, China.
Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing, China.
Front Oncol. 2023 Jan 20;12:1083440. doi: 10.3389/fonc.2022.1083440. eCollection 2022.
To evaluate the long-term survival and treatment-related toxicities of helical tomotherapy (HT) in nasopharyngeal carcinoma (NPC) patients.
One hundred and ninety newly diagnosed non-metastatic NPC patients treated with HT from September 2007 to August 2012 were analyzed retrospectively. The dose at D95 prescribed was 70-74Gy, 60-62.7Gy and 52-56Gy delivered in 33 fractions to the primary gross tumor volume (pGTVnx) and positive lymph nodes (pGTVnd), the high risk planning target volume (PTV1), and the low risk planning target volume (PTV2), respectively, using simultaneous integrated boost technique. The statistical analyses were performed and late toxicities were evaluated and scored according to the Common Terminology Criteria for Adverse Events (version 3.0).
The median follow-up time was 145 months. The 10-year local relapse-free survival (LRFS), nodal relapse-free survival (NRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were 94%, 95%, 86%, and 77.8%; respectively. Fifty (26.3%) patients had treatment-related failures at the last follow-up visit. Distant metastasis, occurred in 25 patients, was the major failure pattern. Multivariate analysis showed that age and T stage were independent predictors of DMFS and OS, Concomitant chemotherapy improved overall survival, but anti-EGFR monoclonal antibody therapy failed. The most common late toxicities were mainly graded as 1 or 2.
Helical tomotherapy with simultaneous integrated boost technique offered excellent long-term outcomes for NPC patients, with mild late treatment-related toxicities. Age and clinical stage were independent predictors of DMFS and OS. And, concurrent chemotherapy means better OS. Further prospective study is needed to confirm the superiority of this technology and to evaluate the roles of anti-EGFR monoclonal antibody treatment.
评估螺旋断层放射治疗（HT）对鼻咽癌（NPC）患者的长期生存情况及治疗相关毒性。
回顾性分析2007年9月至2012年8月期间接受HT治疗的190例新诊断的非转移性NPC患者。采用同步整合加量技术，分别给予原发大体肿瘤体积（pGTVnx）和阳性淋巴结（pGTVnd）、高危计划靶区（PTV1）以及低危计划靶区（PTV2）规定剂量的D95，分别为70 - 74Gy、60 - 62.7Gy和52 - 56Gy，分33次给予。进行统计分析，并根据不良事件通用术语标准（第3.0版）评估晚期毒性并评分。
中位随访时间为145个月。10年局部无复发生存率（LRFS）、区域无复发生存率（NRFS）、远处转移无复发生存率（DMFS）和总生存率（OS）分别为94%、95%、86%和77.8%。50例（26.3%）患者在最后一次随访时有治疗相关失败情况。远处转移发生在25例患者中，是主要的失败模式。多因素分析显示年龄和T分期是DMFS和OS的独立预测因素，同步化疗可提高总生存率，但抗表皮生长因子受体（EGFR）单克隆抗体治疗无效。最常见的晚期毒性主要分级为1级或2级。
采用同步整合加量技术的螺旋断层放射治疗为NPC患者提供了良好的长期疗效，且晚期治疗相关毒性较轻。年龄和临床分期是DMFS和OS的独立预测因素。并且，同步化疗意味着更好的总生存率。需要进一步的前瞻性研究来证实该技术的优越性，并评估抗EGFR单克隆抗体治疗的作用。
