[an error occurred while processing this directive]|[an error occurred while processing this directive]
416例鼻咽癌调强放疗远期生存与影响因素分析
易俊林, 高黎, 黄晓东, 罗京伟, 肖建平, 李素艳, 王凯, 张世平, 曲媛, 徐国镇,
100021 北京,中国医学科学院北京协和医学院肿瘤医院肿瘤研究所放疗科
Nasopharyngeal carcinoma treated by intensity-modulated radiotherapy:long-term results of 416 patients
YI Jun-lin, GAO Li, HUANG Xiao-dong, LUO Jing-wei, Xiao Jian-ping, LI Su-yan, WANG Kai, ZHANG Shi-ping, QU Yuan, XU Guo-zhen
Department of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021,China Corresponding author:Gao Li,Email:li_gao2008@yahoo.com.cn
Abstract：Objective To summarize the long term outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy. Methods From Nov 2001 to Dec 2009, totally 416 newly diagnosed NPC patients was treated in our hospital. The prescribed dose was 70－78 Gy to the gross tumor volume and 70 Gy to the positive neck nodes, 60 Gy to the clinical target volume, and 50－56 Gy to the clinically negative neck. Among 333 stage Ⅲ/Ⅳ patients according to the 2010 UICC staging system, 187 received concurrent chemoradiotherapy with a regimen of weekly cisplatin 30 mg/m2.Local control rate (LC), overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were estimated using the Kaplan-Meier method. Results The follow up rate is 98.0%.158 patients was followed up more than 5 years. The 5 years LC, OS, DFS and DMFS of whole group were 87.7%,82.1%,71.8% and 84.5%. Sex, Age, T stage and N stage were independent prognostic factors for OS (χ2=4.59,11.20,19.40,18.00, P=0.03,0.00,0.00,0.00), T and N stage were independent prognostic factors for DFS (χ2=33.50,21.20,P=0.00,0.00) and DMFS (χ2=11.90,14.60,P=0.01,0.01). The 5 years LC, OS, DFS and DMFS for local-regional advanced disease with or without concurrent chemotherapy was 82.2% and 90.7%(χ2=1.72,P=0.19),70.2% and 83.4%(χ2=1.42, P=0.23), 62.8% and 73.2%(χ2=2.83, P=0.09),78.0% and 83.2%(χ2=0.37,P=0.55) respectively. Conclusions The long term outcomes of nasopharyngeal carcinoma treated by intensity-modulated radiotherapy was encouraged. The role of concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma treated by intensity-modulated radiotherapy needs further investigated.
. Nasopharyngeal carcinoma treated by intensity-modulated radiotherapy:long-term results of 416 patients[J]. Chinese Journal of Radiation Oncology, 2012, 21(3): 196-200.
[1] Lee WM, Sze WM, Au SK, et al. Treatment results for nasopharyngeal carcinoma in the modern era:the Hongkong experience. Int J Radiat Oncol Biol Phys,2005,61:1107-1116. [2] Lu T, Luo W, Zhao C, et al. Retrospective analysis of 934 primary nasopharyngeal carcinoma (NPC) patients treated with conventional external beam radiotherapy alone. Int J Radiat Oncol Biol Phys,2004,60 Suppl 1:508-509. [3] Yi JL, Huang XD, Gao L, et al. Nasopharyngeal carcinoma treated by radical radiotherapy alone:ten-year experience of a single institution. Int J Radiat Oncol Biol Phys,2006,65:161-168. [4] Hunt MA, Zelefsky MJ, Wolden S, et al. Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer. Int J Badiat Oneol Biol Phys,2001,49:623-632. [5] Xia P, Fu KK, Wong GW, et al. Comparison of treatment plans involving intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys,2000,48:329-337. [6] 肖巍魏,卢泰祥,赵充,等.调强放疗技术对鼻咽癌UICC/AJCC分期的影响.中华放射肿瘤学杂志,2010,19:181-184. [7] 赵充,肖巍巍,韩非,等.419例鼻咽癌患者调强放疗疗效和影响.中华放射肿瘤学杂志,2010,19:191-196. [8] 易俊林,高黎,徐国镇,等.147例鼻咽癌调强放疗结果分析.中华放射肿瘤学杂志,2008,17:329-334. [9] 潘建基,张瑜,林少俊,等.1706例鼻咽癌放疗远期疗效分析.中华放射肿瘤学杂志,2008,17:247-251. [10] 苏胜发,卢泰祥,赵充,等.基于调强放疗远期结果的鼻咽癌’92分期和2008分期结果比较.中华放射肿瘤学杂志,2010,19:185-189. [11] Al-Sarraf M, LeBlanc M, Giri PG, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer:phase Ⅲ randomized Intergroup study 0099. J Clin Oncol,1998,16:1310-1317. [12] Al-Sarraf M, LeBlanc M, Giri PG, et al. Superiority of 5-year survival with chemoradiotherapy vs radiotherapy in patients with locally advanced nasopharyngeal cancer. Intergroup 0099 Phase Ⅲ study:final report. Proc Am Soc Clin Oncol,2001,20:227. [13] Lin JC, Jan JS, Hsu CY, et al. Phase Ⅲ study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma:positive effect on overall and progression-free survival. J Clin Oncol,2003,21:631-637. [14] Wee J, Tan EH, Tai BC, et al. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American joint committee on cancer/international union against cancer stage Ⅲ and Ⅳ nasopharyngeal cancer of the endemic variety. J Clin Oncol,2005,23:6730-6738. [15] Lee AW, Lau WH, Tung SY, et al. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma:NPC-9901 trial by the Hong Kong nasopharyngeal cancer study group. J Clin Oncol,2005,23:6966-6975. [16] Lee AW, Tung SY, Chan AT, et al. Preliminary results of a randomized study (NPC-9902 trial) on therapeutic gain by concurrent chemotherapy and/or accelerated fractionation for locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys,2006,66:142-151. [17] Chan AT, Leung SF, Ngan RK, et al. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst,2005,97:536-539. [18] Kwong DL, Sham JS, Au GK, et al. Concurrent and adjuvantchemotherapy for nasopharyngeal carcinoma:a factorial study.
J Clin Oncol,2004,22:2643-2653. [19] Lee AW, Tung SY, Chan AT, et al. Final report of NPC-9902 trial on therapeutic gain and late toxicities by concurrent-adjuvant chemotherapy and/or accelerated fractionation for T3－4N0－1M0 nasopharyngeal carcinoma. Eur J Cancer,2009,7 Suppl:22. [20] Lee AW, Tung SY, Chua DTT, et al. Final report of NPC-9901 trial on therapeutic gain and late toxicities attributed to concurrent-adjuvant chemotherapy for T1－4N2－3M0 nasopharyngeal carcinoma. Eur J Cancer,2009,7 Suppl:471. [21] Lee AW, Tung SY, Ngan RKC, et al. Factors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma:Combined analyses of NPC-9901 and NPC-9902 trials. Eur J Cancer,2011,47:656-666. [22] Yan JH, Qin DX, Hu YH, et al. Management of local residual primary lesion of nasopharyngeal carcinoma (NPC):are higher doses beneficial? Int J Radiat Oncol Biol Phys,1989,16:1465-1469. [23] Yan JH, Xu GZ, Hu YH, et al. Management of local residual primary lesion of nasopharyngeal carcinoma:Ⅱ. Results of prospective randomized trial on booster dose. Int J Radiat Oncol Biol Phys,1990,18:295-298. [24] 肖建平,徐国镇,高黎,等.鼻咽癌初程放疗后残存的分次X-刀治疗初探.中华放射肿瘤学杂志,2005,14:77-80. [25] O′Sullivan B. Nasopharynx cancer:therapeutic value of chemoradiotherapy. Int J Radiat Oncol Biol Phys,2007,69:118-121.
2012, Vol. 21 
