Cheng S H, Jian J J, Tsai S Y, Chan K Y, Yen L K, Chu N M, Tan T D, Tsou M H, Huang A T
Clinical Protocol Office and Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
Int J Radiat Oncol Biol Phys. 1998 Jul 1;41(4):755-62. doi: 10.1016/s0360-3016(98)00092-3.
Concurrent chemotherapy and radiotherapy (CCRT) are effective in treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). However, the prognostic factors after CCRT have not been evaluated. We therefore attempt to evaluate factors that influence treatment outcomes following CCRT.
Seventy-four (5 in stage III and 69 in stage IV) patients with locoregionally advanced NPC were treated with CCRT. Radiotherapy was delivered either at 2 Gray (Gy) per fraction per day up to 70 Gy or 1.2 Gy, 2 fractions per day, up to 74.4 Gy. Concurrent chemotherapy consisted of cisplatin and 5-fluorouracil. Cox proportional-hazards model was used to analyze the prognostic factors which included age, gender, pathologic type, T, N, lactate dehydrogenase (LDH), and infiltration of the clivus.
The primary tumor control rate at 3 years was 96.7% (95% confidence interval [CI]: 92.5-100), distant metastasis-free survival 81.1% (95% CI: 70.6-91.6), disease-free survival 77.0% (95% CI: 65.3-88.7), and overall survival 79.8% (95% CI: 69.2-90.4) with a median follow-up interval of 29 months (range 15-74 months). Cox proportional-hazards model revealed that infiltration of the clivus and serum level of LDH before treatment were the most two important factors that predict distant metastases. Infiltration of the clivus and the serum LDH level greater than 410 U/L were strongly associated with distant metastasis-free survival (p = 0.0004 and p = 0.0002, respectively). When these two risk factors were considered together, no distant metastasis was observed in 40 patients with both intact clivus and LDH < or = 410 U/L. On the contrary, 13 of the remaining 34 patients with at least one risk factor developed distant metastasis (p = 0.0001).
Our study demonstrates that CCRT can improve the primary tumor control of 96.7% and disease-free survival of 77.0% at 3-year follow-up. Distant metastasis, however, is the major cause of failure. Infiltration of the clivus by the tumor and LDH greater than 410 U/L are the two independent and useful prognostic factors in patients with locoregionally advanced NPC who were treated with CCRT. Good- and poor-risk patients can be distinguished by virtue of their having both conditions.
同步放化疗（CCRT）在局部晚期鼻咽癌（NPC）治疗中有效。然而，CCRT后的预后因素尚未得到评估。因此，我们试图评估影响CCRT后治疗结果的因素。
74例（III期5例，IV期69例）局部晚期NPC患者接受了CCRT治疗。放疗采用每日每次2Gy，总量达70Gy，或每日2次，每次1.2Gy，总量达74.4Gy。同步化疗包括顺铂和5-氟尿嘧啶。采用Cox比例风险模型分析预后因素，包括年龄、性别、病理类型、T分期、N分期、乳酸脱氢酶（LDH）以及斜坡浸润情况。
3年时原发肿瘤控制率为96.7%（95%置信区间[CI]：92.5 - 100），无远处转移生存率为81.1%（95%CI：70.6 - 91.6），无病生存率为77.0%（95%CI：65.3 - 88.7），总生存率为79.8%（95%CI：69.2 - 90.4）；中位随访时间为29个月（范围15 - 74个月）。Cox比例风险模型显示，斜坡浸润和治疗前血清LDH水平是预测远处转移的两个最重要因素。斜坡浸润和血清LDH水平大于410U/L与无远处转移生存率密切相关（分别为p = 0.0004和p = 0.0002）。当同时考虑这两个危险因素时，40例斜坡完整且LDH≤410U/L的患者未观察到远处转移。相反，其余34例至少有一个危险因素的患者中有13例发生了远处转移（p = 0.0001）。
我们的研究表明，CCRT在3年随访时可使原发肿瘤控制率达到96.7%，无病生存率达到77.0%。然而，远处转移是主要的失败原因。肿瘤对斜坡的浸润和LDH大于410U/L是接受CCRT治疗的局部晚期NPC患者的两个独立且有用的预后因素。根据这两种情况可区分高风险和低风险患者。
