Uchinami Yusuke, Yasuda Koichi, Minatogawa Hideki, Dekura Yasuhiro, Nishikawa Noboru, Kinoshita Rumiko, Nishioka Kentaro, Katoh Norio, Mori Takashi, Otsuka Manami, Miyamoto Naoki, Suzuki Ryusuke, Kobashi Keiji, Shimizu Yasushi, Taguchi Jun, Tsushima Nayuta, Kano Satoshi, Homma Akihiro, Aoyama Hidefumi
Department of Radiation Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan.
Radiat Oncol J. 2024 Mar;42(1):74-82. doi: 10.3857/roj.2023.00374. Epub 2024 Mar 18.
To investigate the clinical significance of adaptive radiotherapy (ART) in locally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT).
Eligible patients were treated with concurrent chemoradiotherapy using IMRT. Planning computed tomography in ART was performed during radiotherapy, and replanning was performed. Since ART was started in May 2011 (ART group), patients who were treated without ART up to April 2011 (non-ART group) were used as the historical control. The Kaplan-Meier method was used to calculate overall survival (OS), locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). LRFS for the primary tumor (LRFS_P) and regional lymph node (LRFS_LN) were also studied for more detailed analysis. Statistical significance was evaluated using the log-rank test for survival.
The ART group tended to have higher radiation doses. The median follow-up period was 127 months (range, 10 to 211 months) in the non-ART group and 61.5 months (range, 5 to 129 months) in the ART group. Compared to the non-ART group, the ART group showed significantly higher 5-year PFS (53.8% vs. 81.3%, p = 0.015) and LRFS (61.2% vs. 85.3%, p = 0.024), but not OS (80.7% vs. 80.8%, p = 0.941) and DMFS (84.6% vs. 92.7%, p = 0.255). Five-year LRFS_P was higher in the ART group (61.3% vs. 90.6%, p = 0.005), but LRFS_LN did not show a significant difference (91.9% vs. 96.2%, p = 0.541).
Although there were differences in the patient backgrounds between the two groups, this study suggests the potential effectiveness of ART in improving locoregional control, especially in the primary tumor.
探讨自适应放疗（ART）在局部晚期鼻咽癌调强放疗（IMRT）中的临床意义。
符合条件的患者采用IMRT同步放化疗。ART组在放疗期间进行计划计算机断层扫描并重新计划。自2011年5月开始采用ART（ART组），将2011年4月以前未采用ART治疗的患者（非ART组）作为历史对照。采用Kaplan-Meier法计算总生存期（OS）、局部区域无复发生存期（LRFS）、无进展生存期（PFS）和远处转移无进展生存期（DMFS）。还研究了原发肿瘤的LRFS（LRFS_P）和区域淋巴结的LRFS（LRFS_LN）以进行更详细的分析。采用对数秩检验评估生存的统计学意义。
ART组的放疗剂量往往更高。非ART组的中位随访期为127个月（范围10至211个月），ART组为61.5个月（范围5至129个月）。与非ART组相比，ART组的5年PFS（53.8%对81.3%，p = 0.015）和LRFS（61.2%对85.3%，p = 0.024）显著更高，但OS（80.7%对80.8%，p = 0.941）和DMFS（84.6%对92.7%，p = 0.255）无差异。ART组的5年LRFS_P更高（61.3%对90.6%，p = 0.005），但LRFS_LN无显著差异（91.9%对96.2%，p = 0.541）。
尽管两组患者背景存在差异，但本研究提示ART在改善局部区域控制方面具有潜在有效性，尤其是对原发肿瘤。
