Department of Radiation Oncology, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou 510095, China.
Department of Surgery, Guangdong Women and Children Hospital, Guangzhou 511400, China.
Oral Oncol. 2024 Nov;158:107001. doi: 10.1016/j.oraloncology.2024.107001. Epub 2024 Aug 30.
To identify the failure patterns and prognostic factors of nonmetastatic nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era.
Data on 847 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2012 and 2016 were retrospectively reviewed. Survival outcome, failure patterns and prognosis factors were analyzed.
The 5-year local relapse-free survival, nodal relapse-free survival, distant metastasis-free survival, disease-free survival, and overall survival rates were 94.3%, 95.3%, 84.8%, 76.5% and 85.7%, respectively. The major local recurrence sites were the nasopharynx (91.5%, 43/47) and skull base (68.1%, 32/47); 39 patients had in-field failures, four had marginal failures, and four had out-field failures. Level IIb (62.2%, 23/37) was the most frequent regional recurrence site, followed by IIa (35.1%, 13/37) and retropharyngeal region (32.4%, 12/37); 35 cases had in-field failure alone, one had out-field failure alone, and one had both in- and out-field failure. TNM stage was the most significant factor for prognosis prediction. 402 (47.5%) patients had acute adverse events of grade 3 or 4; leukopenia (31.5%) and mucositis (26.7%) was the most common hematological and non-hematological event, respectively. Late complications were slight or moderate damages; xerostomia (647/847, 76.4%) and hearing impairment (422/847, 49.8%) remained the most troublesome.
NPC patients treated with IMRT obtained satisfactory survival outcomes. The key failure pattern was distant metastasis. The main pattern of local-regional failure was in-field failure. Screening high risk patients with distant metastases and optimizing radiotherapy targets should be studied.
在调强放疗（IMRT）时代，确定非转移性鼻咽癌（NPC）的失败模式和预后因素。
回顾性分析了 2012 年至 2016 年间接受 IMRT 治疗的 847 例初诊、无播散性 NPC 患者的数据。分析了生存结果、失败模式和预后因素。
5 年局部无复发生存率、淋巴结无复发生存率、远处转移无复发生存率、无病生存率和总生存率分别为 94.3%、95.3%、84.8%、76.5%和 85.7%。主要局部复发部位为鼻咽部（91.5%，43/47）和颅底（68.1%，32/47）；39 例患者发生场内失败，4 例发生边缘失败，4 例发生场外失败。IIb 区（62.2%，23/37）是最常见的区域复发部位，其次是 IIa 区（35.1%，13/37）和咽后区（32.4%，12/37）；35 例患者仅发生场内失败，1 例发生场外失败，1 例发生场内和场外失败。TNM 分期是预测预后的最重要因素。402 例（47.5%）患者发生 3 或 4 级急性不良反应；白细胞减少（31.5%）和黏膜炎（26.7%）分别是最常见的血液学和非血液学事件。晚期并发症为轻度或中度损害；口干（647/847，76.4%）和听力障碍（422/847，49.8%）仍是最麻烦的。
接受 IMRT 治疗的 NPC 患者获得了满意的生存结果。主要失败模式为远处转移。局部区域失败的主要模式为场内失败。应研究筛选有远处转移风险的高危患者并优化放疗靶区。
