内镜手术与调强放疗治疗局部晚期复发鼻咽癌的多中心、病例匹配比较。
Endoscopic surgery versus intensity-modulated radiotherapy in locally advanced recurrent nasopharyngeal carcinoma: a multicenter, case-matched comparison.
机构信息
Department of Otolaryngology and Head and Neck Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
出版信息
J Otolaryngol Head Neck Surg. 2023 Nov 6;52(1):72. doi: 10.1186/s40463-023-00656-3.
BACKGROUND
The management of locally advanced recurrent nasopharyngeal carcinoma (rNPC) is challenging. The objective of our study was to compare salvage endoscopic nasopharyngectomy (ENPG) with intensity-modulated radiotherapy (IMRT) in clinical outcomes and complications of locally advanced rNPC.
METHODS
Patients with histologically confirmed rNPC in rTNM stages were retrospectively enrolled between January 2013 and December 2019 in this multicenter, case-matched study. The baseline clinicopathological characteristics of patients were balanced by propensity score matching between the ENPG and IMRT groups. ENPG was performed in patients with easily or potentially resectable tumors. The oncological outcomes as well as treatment-related complications were compared between two groups.
RESULTS
A total of 176 patients were enrolled and 106 patients were matched. The ENPG group (n = 53) and the IMRT group (n = 53) showed comparable outcomes in the 3-year overall survival rate (68.4% vs. 65.4%, P = 0.401), cancer-specific survival rate (80.9% vs. 74.4%, P = 0.076), locoregional failure-free survival rate (36.6% vs. 45.3%, P = 0.076), and progression-free survival rate (27.5% vs. 32.3%, P = 0.216). The incidence of severe treatment-related complications of patients in the ENPG group was lower than that in the IMRT group (37.7% vs. 67.9%, P = 0.002). The most common complications were post perioperative hemorrhage (13.2%) in ENPG group and temporal lobe necrosis (47.2%) in IMRT group, respectively.
CONCLUSION
Salvage ENPG exhibits comparable efficacy but less toxicities than IMRT in carefully screened patients with locally advanced rNPC, which may be a new choice of local treatment.
背景
局部晚期复发性鼻咽癌（rNPC）的治疗具有挑战性。本研究旨在比较挽救性内镜下鼻咽切除术（ENPG）与调强放疗（IMRT）在局部晚期 rNPC 患者的临床结局和并发症方面的差异。
方法
本多中心、病例匹配研究回顾性纳入了 2013 年 1 月至 2019 年 12 月期间经组织学证实为 rNPC 且 rTNM 分期为局部晚期的患者。通过倾向评分匹配平衡了 ENPG 组和 IMRT 组患者的基线临床病理特征。ENPG 适用于肿瘤易于或可能切除的患者。比较两组患者的肿瘤学结局和治疗相关并发症。
结果
共纳入 176 例患者，其中 106 例进行了匹配。ENPG 组（n=53）和 IMRT 组（n=53）患者的 3 年总生存率（68.4% vs. 65.4%，P=0.401）、癌症特异性生存率（80.9% vs. 74.4%，P=0.076）、无局部区域失败生存率（36.6% vs. 45.3%，P=0.076）和无进展生存率（27.5% vs. 32.3%，P=0.216）相当。ENPG 组患者严重治疗相关并发症的发生率低于 IMRT 组（37.7% vs. 67.9%，P=0.002）。ENPG 组最常见的并发症是术后出血（13.2%），IMRT 组最常见的并发症是颞叶坏死（47.2%）。
结论
在经过精心筛选的局部晚期 rNPC 患者中，挽救性 ENPG 的疗效与 IMRT 相当，但毒性更小，可能成为局部治疗的新选择。
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