Liao Kai, Zhang Jian, Qiu Wenze, Zheng Ronghui
Department of Radiotherapy, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, China.
Front Oncol. 2024 Nov 18;14:1424804. doi: 10.3389/fonc.2024.1424804. eCollection 2024.
In the era of intensity-modulated radiation therapy (IMRT), the status of concurrent chemoradiotherapy(CCRT) for stage II nasopharyngeal carcinoma(NPC), particularly for patients in T2N1 subtype, remains controversial nowadays.
This study exclusively aims to explore the value of concurrent chemotherapy in the treatment of T2N1 NPC under IMRT mode.
A retrospective analysis was conducted on 218 cases of T2N1 NPC patients treated at our hospital from January 2015 to December 2020, comprising 75 cases treated with IMRT and 143 cases treated with CCRT. The study compared therapeutic outcomes and side effects between the two groups.
The 5-year progression-free survival (PFS), overall survival (OS), locoregional relapse-free survival (LRRFS) and,distant metastasis-free survival (DMFS) estimated by the K-M method for the IMRT vs. CCRT groups were 86.1% vs. 85.1%,89.3% vs. 87.9%, 95.9% vs. 94.9%,and 90.2% vs. 89.1%, respectively, with no statistically significant differences (Log-rank >0.05 for all comparisons). Cox regression analysis identified Epstein-Barr virus (EBV) DNA copy level (≥1000 vs. <1000 copies/ml)(the cutoff value was determined through the ROC curve), lymph node necrosis (yes vs. no) and extra-nodal extension (yes vs. no) as independent prognostic factors for PFS(<0.05 for all comparisons). Subgroup analysis indicated an interaction effect between lymph node necrosis (yes vs. no) and treatment modality (IMRT vs. CCRT) regarding PFS ( for interaction<0.05). In the subgroup with lymph node necrosis, IMRT compared to CCRT had a poorer prognosis (HR: 1.85,95% CI: 1.02-3.50). CCRT was noted to increase acute hematological, gastrointestinal and other toxicities.
This study provides a reference for clinical treatment decisions in T2N1 NPC. For the entire population of T2N1 NPC, the therapeutic effects of IMRT and CCRT are comparable, with increased acute toxicities in the latter. However, for patients with EBV-DNA copy level ≥1000 copies/ml, lymph node necrosis and extra-nodal extension, CCRT may be considered as appropriate. Particularly, patients with lymph node necrosis may be potential beneficiaries for CCRT.
在调强放射治疗（IMRT）时代，II期鼻咽癌（NPC）同步放化疗（CCRT）的地位，尤其是T2N1亚型患者的同步放化疗地位，目前仍存在争议。
本研究专门旨在探讨同步化疗在IMRT模式下治疗T2N1 NPC中的价值。
对2015年1月至2020年12月在我院治疗的218例T2N1 NPC患者进行回顾性分析，其中75例接受IMRT治疗，143例接受CCRT治疗。该研究比较了两组之间的治疗效果和副作用。
IMRT组与CCRT组采用K-M法估计的5年无进展生存期（PFS）、总生存期（OS）、局部区域无复发生存期（LRRFS）和远处无转移生存期（DMFS）分别为86.1%对85.1%、89.3%对87.9%、95.9%对94.9%和90.2%对89.1%，差异均无统计学意义（所有比较的Log-rank>0.05）。Cox回归分析确定，爱泼斯坦-巴尔病毒（EBV）DNA拷贝水平（≥1000对<1000拷贝/毫升）（临界值通过ROC曲线确定）、淋巴结坏死（是对否）和结外扩展（是对否）是PFS的独立预后因素（所有比较<0.05）。亚组分析表明，在PFS方面，淋巴结坏死（是对否）与治疗方式（IMRT对CCRT）之间存在交互作用（交互作用P<0.05）。在有淋巴结坏死的亚组中，与CCRT相比，IMRT的预后较差（HR：1.85，95%CI：1.02-3.50）。注意到CCRT会增加急性血液学、胃肠道和其他毒性。
本研究为T2N1 NPC的临床治疗决策提供了参考。对于整个T2N1 NPC人群，IMRT和CCRT的治疗效果相当，后者的急性毒性增加。然而，对于EBV-DNA拷贝水平≥1000拷贝/毫升、有淋巴结坏死和结外扩展的患者，可考虑适当采用CCRT。特别是，有淋巴结坏死的患者可能是CCRT的潜在受益者。
