Lee A W, Law S C, Foo W, Poon Y F, Cheung F K, Chan D K, Tung S Y, Thaw M, Ho J H
Institute of Radiology and Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Int J Radiat Oncol Biol Phys. 1993 Aug 1;26(5):773-82. doi: 10.1016/0360-3016(93)90491-d.
To study the value of re-irradiation, the overall survival and pattern of failures for patients with nasopharyngeal recurrence.
All the 891 patients with local recurrence following radiotherapy for nasopharyngeal carcinoma during 1976-1981 were retrospectively analyzed. Only 70% of them had local failure alone at the time of detection, and the T-stage distribution (by Ho's system) was 31% rT1, 16% rT2, 51% rT3, and 1% rT?. Seven hundred and six (79%) patients had been re-irradiated with various techniques and doses. Among those who failed, 50 had further irradiation.
The overall 5- and 10-year actuarial cancer-specific survival rates were 14% and 9%, respectively. Patients with rT3 disease had the worst prognosis. Successful local salvage was achieved in 32% of those re-irradiated (26% of the whole series). The highest control rate was achieved by those treated with external radiotherapy to 60 Gy (equivalent) or above. Only 8/50 patients responded to the third course of radiotherapy. The cumulative incidence of late post-re-irradiation sequelae was 24%, and the treatment mortality rate 1.8%. Besides local failure, 54% had regional relapse and/or distant metastasis. Thus, only 16% of recurrent patients were totally disease-free at final assessment.
The overall prognosis for patients with nasopharyngeal recurrence was grave. High dose re-irradiation could achieve successful local salvage in a substantial number of patients with early recurrence, but late complications did occur. Furthermore, high incidence of failure at other sites was observed.
研究再程放疗的价值、鼻咽癌复发患者的总生存率及失败模式。
对1976年至1981年间接受鼻咽癌放疗后局部复发的891例患者进行回顾性分析。仅70%的患者在检测时仅有局部失败，T分期分布（按Ho氏系统）为31%为rT1、16%为rT2、51%为rT3、1%为rT?。706例（79%）患者采用不同技术和剂量进行了再程放疗。在那些失败的患者中，50例接受了进一步放疗。
5年和10年的精算癌症特异性生存率分别为14%和9%。rT3期疾病患者预后最差。再程放疗患者中32%（占整个系列的26%）实现了成功的局部挽救。接受60Gy（等效剂量）或更高剂量外照射治疗的患者控制率最高。50例患者中仅8例对第三程放疗有反应。再程放疗后晚期后遗症的累积发生率为24%，治疗死亡率为1.8%。除局部失败外，54%有区域复发和/或远处转移。因此，最终评估时仅有16%的复发患者完全无病。
鼻咽癌复发患者的总体预后严重。高剂量再程放疗可使相当数量的早期复发患者成功实现局部挽救，但确实会发生晚期并发症。此外，还观察到其他部位的高失败率。
