Xiao Xiao-Tang, Zou Shi-Qian, Chen Yu-Pei, Guo Rui, Tang Ling-Long, Sun Ying, Ma Jun, Li Wen-Fei
State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.
J Cancer. 2024 Jan 1;15(2):456-465. doi: 10.7150/jca.88148. eCollection 2024.
To investigate the patterns of local failure and prognosis in patients with locally recurrent nasopharyngeal carcinoma (rNPC) after primary intensity-modulated radiotherapy (IMRT). The data of 298 patients with locally rNPC after IMRT were retrospectively analyzed. Magnetic resonance images of the initial and recurrent tumors were reviewed and, for patients with extra-nasopharyngeal local recurrence, the gross tumor volume of local recurrence was transferred to the original IMRT plan for dosimetry analysis. Significant prognostic factors for overall survival (OS) were selected by multivariate Cox regression analysis. The commonest recurrence sites were the nasopharynx (93%, 277/298) and skull base (53.7%, 160/298). Of the 21 patients with extra-nasopharyngeal recurrence (19 cases valid), 12 had in-field failures, 4 had marginal failures, and 3 had out-field failures. The ethmoid sinus (57.1%, 4/7) and nasal cavity (28.6%, 2/7) were the most frequent sites of marginal and out-field failures. After median follow-up of 37 months, the 3-year and estimated 5-year OS rates were 57.3% and 41.7%, respectively. Multivariate analysis showed that age, recurrence interval, plasma Epstein-Barr virus (EBV) DNA level, and recurrent T stage were independent prognostic factors for OS. Local failure after IMRT occurs most commonly in the nasopharynx and skull base. In patients with extra-nasopharyngeal recurrence, in-field failure remains the main failure pattern, and marginal and out-field failures mainly occur in the ethmoid sinus and nasal cavity. Elder age, shorter recurrence interval, detectable plasma EBV DNA, and advanced recurrent T stage are negative predictors of OS in patients with rNPC.
探讨初程调强放疗（IMRT）后局部复发鼻咽癌（rNPC）患者的局部失败模式及预后。回顾性分析298例IMRT后局部复发rNPC患者的数据。复查初发及复发肿瘤的磁共振图像，对于鼻咽外局部复发患者，将局部复发的大体肿瘤体积转移至原IMRT计划进行剂量学分析。通过多因素Cox回归分析选择总生存（OS）的显著预后因素。最常见的复发部位是鼻咽（93%，277/298）和颅底（53.7%，160/298）。在21例鼻咽外复发患者中（19例有效），12例为野内失败，4例为边缘失败，3例为野外失败。筛窦（57.1%，4/7）和鼻腔（28.6%，2/7）是边缘和野外失败最常见的部位。中位随访37个月后，3年和估计5年OS率分别为57.3%和41.7%。多因素分析显示，年龄、复发间隔、血浆EB病毒（EBV）DNA水平和复发T分期是OS的独立预后因素。IMRT后局部失败最常见于鼻咽和颅底。在鼻咽外复发患者中，野内失败仍是主要的失败模式，边缘和野外失败主要发生在筛窦和鼻腔。年龄较大、复发间隔较短、可检测到血浆EBV DNA以及复发T分期较晚是rNPC患者OS的阴性预测因素。
