Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Strahlenther Onkol. 2024 Dec;200(12):1057-1065. doi: 10.1007/s00066-024-02309-4. Epub 2024 Oct 25.
Intensity-modulated radiotherapy (IMRT) is the standard treatment approach for nasopharyngeal cancer (NPC). IMRT enables effective sparing of the parotid glands and reduces the risk of xerostomia, a common complication of head and neck irradiation. Nevertheless, it is essential to determine whether the parotid-sparing IMRT (ps-IMRT) technique yields increased intra-/periparotid recurrence rates, which constitutes the main purpose of this study.
Patients with a diagnosis of NPC that received definitive chemoradiotherapy/radiotherapy (CRT/RT) between 1991 and 2021 were evaluated retrospectively. Patients with intra-/periparotid recurrence were detected and prognostic factors for recurrence were sought.
A total of 746 patients were evaluated. Two-dimensional (2D)-RT was applied to 541, 3D conformal RT (3D-CRT) to 10, and ps-IMRT to 195 patients. After a median 85-month follow-up, one (0.18%) patient who received 2D-RT and four (2%) patients who received ps-IMRT experienced an intra-/periparotid recurrence. The median time to intra-/periparotid recurrence was 11.9 months. All patients had been diagnosed with a metastatic lymph node > 2 cm at level II of the ipsilateral neck. In addition, all recurrences occurred on the same side as the positive neck at the time of diagnosis. The 3‑year overall survival, locoregional recurrence-free survival, and distant metastasis-free survival rates were 80%, 40%, and 60%, respectively.
Intra-/periparotid recurrence is extremely rare in NPC. However, it is still possible to identify and characterize particular risk factors, which include a metastatic lymph node at level II, particularly > 2 cm, and multinodal disease at the time of diagnosis.
调强放疗（IMRT）是鼻咽癌（NPC）的标准治疗方法。IMRT 能有效地保护腮腺，降低头颈部放疗后口干这一常见并发症的风险。然而，确定是否能通过保腮腺调强放疗（ps-IMRT）技术降低腮腺内/旁复发率是至关重要的，这也是本研究的主要目的。
回顾性评估了 1991 年至 2021 年间接受根治性放化疗/放疗（CRT/RT）的 NPC 患者。对发生腮腺内/旁复发的患者进行检测，并寻找复发的预后因素。
共评估了 746 例患者。541 例接受二维（2D）RT，10 例接受三维适形放疗（3D-CRT），195 例接受 ps-IMRT。中位随访 85 个月后，1 例（0.18%）接受 2D-RT 的患者和 4 例（2%）接受 ps-IMRT 的患者发生腮腺内/旁复发。腮腺内/旁复发的中位时间为 11.9 个月。所有患者均被诊断为同侧颈部 II 水平转移性淋巴结>2cm。此外，所有复发均发生在诊断时阳性淋巴结同侧。3 年总生存率、无局部区域复发生存率和无远处转移生存率分别为 80%、40%和 60%。
NPC 中腮腺内/旁复发极为罕见。然而，仍有可能识别并描述特定的危险因素，包括 II 水平的转移性淋巴结，尤其是>2cm，以及诊断时的多灶性疾病。
