调强放疗时代鼻咽癌患者腮腺淋巴结转移的临床治疗考虑。

Clinical treatment considerations in the intensity-modulated radiotherapy era for parotid lymph node metastasis in patients with nasopharyngeal carcinoma.

机构信息

Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.

出版信息

Radiother Oncol. 2023 Sep;186:109802. doi: 10.1016/j.radonc.2023.109802. Epub 2023 Jul 7.

DOI:10.1016/j.radonc.2023.109802

PMID:37423477

Abstract

PURPOSE

No specific irradiation guidelines have been proposed for parotid lymph node (PLN) metastasis in patients with nasopharyngeal carcinoma (NPC). This study aimed to explore the dose prescription and target delineation for PLN metastasis in patients with NPC.

METHODS

With the NPC database from a big-data platform, 10,685 patients with primarily diagnosed, non-distant metastatic, histologically proven NPC and treated with intensity modulated radiotherapy (IMRT) at our center from 2008 to 2019 were reviewed and those with PLN metastasis were enrolled in this study. Dosimetry parameters were collected from the dose-volume histograms (DVH). The primary endpoint was overall survival (OS). Least absolute shrinkage and selection operator regression (LASSO) was operated for variable selection. Multivariate Cox regression analysis was applied to identify the independent prognostic factors.

RESULTS

PLN metastases were identified in 275/10685 (2.5%) patients. Of 367 positive PLN, 199 were in superficial intra-parotid, followed by 70 in deep intra-parotid, 54 in subparotid and 44 in subcutaneous pre-auricular. Better survival outcome was observed in PLN-radical IMRT group, compared with PLN-sparing group. In 190 patients received PLN-radical IMRT, multivariate analysis revealed that D95% of level VIII > 55 Gy was an independent beneficial prognostic factor for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and parotid relapse-free survival (PRFS).

CONCLUSION

Based on the distribution pattern of PLN metastasis in NPC and the result of dose-finding study, involving the ipsilateral level VIII into low-risk clinical target volume (CTV2) is recommended for NPC with PLN metastasis.

摘要

目的

对于鼻咽癌（NPC）患者的腮腺淋巴结（PLN）转移，尚未提出具体的照射指南。本研究旨在探讨 NPC 患者 PLN 转移的剂量处方和靶区勾画。

方法

利用大数据平台的 NPC 数据库，回顾性分析了我中心 2008 年至 2019 年期间治疗的 10685 例初诊、无远处转移、组织学证实的 NPC 患者，且均接受调强放疗（IMRT），将 PLN 转移患者纳入本研究。从剂量-体积直方图（DVH）中收集剂量学参数。主要终点为总生存期（OS）。采用最小绝对收缩和选择算子回归（LASSO）进行变量选择。采用多变量 Cox 回归分析确定独立的预后因素。

结果

在 10685 例患者中，有 275 例（2.5%）患者存在 PLN 转移。在 367 个阳性 PLN 中，199 个位于腮腺浅叶内，其次是 70 个位于腮腺深叶内，54 个位于腮腺下叶内，44 个位于耳前皮下。与 PLN 保留组相比，PLN 根治性 IMRT 组的生存结果更好。在 190 例接受 PLN 根治性 IMRT 的患者中，多变量分析显示，水平 VIII 的 D95%＞55Gy 是总生存（OS）、无进展生存（PFS）、无远处转移生存（DMFS）和腮腺无复发生存（PRFS）的独立预后因素。