鼻咽癌调强放疗长期疗效及预后分析

doi:10.3760/cma.j.issn.1004-4221.2012.06.002

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要

目的评估鼻咽癌调强放疗的长期疗效,分析影响预后的因素。方法回顾分析 299例无远处转移鼻咽癌首程治疗病例资料。鼻咽原发灶及上颈部调强放疗70 Gy,下颈部及锁骨上区用单前野预防性常规放疗54 Gy,5 次/周共30次。鼻咽残存灶采用局部小野IMRT加量或X刀补充照射 4~20 Gy。用Kaplan-Meier方法计算总生存率(OS)、无疾病进展生存率(DPFS)、无远处转移生存率(DMFS)等,Logrank法检验和单因素预后分析,Cox法多因素预后分析。结果全组随访率为99.7%,随访时间满 5年者为 119例。Ⅰ+Ⅱ、Ⅲ、Ⅳ期 5年OS分别为97.1%、82.7%、52.2%(χ²=46.19,P=0.000),DPFS分别为100%、77.6%、57.7%(χ²=23.29,P=0.000),DMFS分别为100%、82.3%、63.7%(χ²=16.57,P=0.000)。男性和女性 5年OS、DPFS、DMFS分别为70.7%和94.1%(χ²=16.82,P=0.000)、71.5%和87.3%(χ²=4.74,P=0.029)、77.2%和89.7%(χ²=4.38,P=0.036);<45岁男性和女性的分别为66.8%和91.2%(χ²=7.07,P=0.008)、59.9%和91.2%(χ²=7.72,P=0.005)、66.4%和94.0%(χ²=8.46,P=0.004),≥45岁的只有OS不同(72.2%和96.0%,χ²=10.19,P=0.001)。多因素分析显示性别、TNM分期、淋巴结包膜受侵均影响OS (χ²=14.27、5.72、17.64,P=0.000、0.017、0.000)、DPFS (χ²=5.33、15.70、10.57,P=0.021、0.000、0.001)、DMFS (χ²=4.30、11.08、21.24,P=0.038、0.001、0.000),颅内受侵、锁骨上淋巴结转移影响OS (χ²=13.32、5.38,P=0.000、0.020)。结论除分期、淋巴结包膜受侵影响预后外,性别也是影响预后因素之一,特别是<45岁男性预后更差。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	肖光莉
	丘熹彬
	王卫华
	曹亚兵
	王余锋

关键词 ：鼻咽肿瘤/放射疗法, 放射疗法,调强, 放射疗法,常规, 预后

Abstract：

Objective To study long-term outcome and prognostic factors of nasopharyngeal carcinoma treated by intensity modulated radiotherapy. Methods A total of 299 patients with non-disseminated nasopharyngeal carcinoma who received initial radiotherapy were analyzed retrospectively. The primary lesion and the upper neck received 70 Gy (5 fraction per week in all 30 fraction) by intensity-modulated radiotherapy (IMRT). The lower neck and the supraclavicular fossa was given 54 Gy (5 fraction per week in all 30 fraction) by a single anterior tangent field with spinal cord block. A median dose of 9.2 Gy (4-20. Gy) was given to the residual primary lesion by IMRT or X-knife. The Kaplan-Meier method was used for calculating the overall survival (OS), disease progression-free survival (DPFS), distant metastasis-free survival (DMFS), Log-rank test was used for evaluating the differences between groups. Multivariate prognostic factor was analyzed by Cox method. Results The follow-up rate was 99.7%. 119 patients were followed-up more than with 5 years. The 5-year OS for stage Ⅰ+Ⅱ, stage Ⅲ and stage Ⅳ were 97.1%,82.7% and 52.2%(χ²=46.19,P=0.000), the 5 years DPFS were 100%,77.6% and 57.7%(χ²=23.29,P=0.000),DMFS were 100%,82.3%,63.7%(χ²=16.57,P=0.000) respectively. The 5 year OS, DPFS and DMFS of male and female were 70.7% vs 94.1%(χ²=16.82,P=0.000), 71.5% vs 87.3%(χ²=4.74,P=0.029) and 77.2% vs 89.7%(χ²=4.38,P=0.036) respectively. For patients who were younger than 45-years, the male had a significantly unfavorable 5-year OS (66.8% vs. 91.2%,χ²=7.07,P=0.008), DPFS (59.9% vs. 91.2%,χ²=7.72,P=0.005) and DMFS (66.4% vs. 94.0%,χ²=8.46,P=0.004);For patients who were old than 45-years, only OS was significantly different between male and female (72.2% vs. 96.0%,χ²=10.19, P=0.001). Multivariate analysis showed theindependent prognostic factors for OS, DPFS, DMFS, were gender (χ²=14.27,5.72,17.64,P=0.000, 0.017,0.000), TNM stage (χ²=5.33,15.70,10.57,P=0.021,0.000,0.001) and lymph nodes capsular invasion (χ²=4.30,11.08,21.24,P=0.038,0.001,0.000). Intracranial invasion and supraclavicular lymph node metastasis were independent prognostic factors for OS (χ²=13.32,5.38,P=0.000,0.020). Conclusions The TNM stage, lymph nodes capsular invasion and gender are independent prognostic factors for nasopharyngeal carcinoma treated by intensity-modulated radiotherapy. The patients of younger than 45-years own a worse outcome.

Key words： Nasopharyngeal neoplasms/radiotherapy Radiotherapy, intensity-modulated Radiotherapy, convention Prognosis

收稿日期: 2012-07-22

基金资助:

澳门科技发展基金会资助项目(No.069/2009/A3)

引用本文:

肖光莉,丘熹彬,王卫华等. 鼻咽癌调强放疗长期疗效及预后分析[J]. 中华放射肿瘤学杂志, 2012, 21(6): 488-491.

XIAO Guang-li,QIU Xi-bin,WANG Wei-hua et al. long-term outcome and prognostic factors of nasopharyngeal carcinoma treated by intensity modulated radiotherapy[J]. Chinese Journal of Radiation Oncology, 2012, 21(6): 488-491.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2012.06.002 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2012/V21/I6/488

[1] Zhang Y, Lin ZA, Pan JJ, et al. Concurrent control study of different radiotherapy for primary nasopharyngeal carcinoma:intensity-modulated radiotherapy versus conventional radiotherapy. Ai Zheng,2009,28:1143-1148.
[2] 刘晓清,罗伟,刘孟忠,等.1093例初治鼻咽癌的疗效和预后分析.中华放射肿瘤学杂志,2008,17:81-86.
[3] Lai SZ, Li WF, Chen L, et al. How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients? Int J Radiat Oncol Biol Phys,2010,80:661-668.
[4] Wolden SL, Chen WC, Pfister DG,et al. Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer:update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys,2006,64:57-62.
[5] 易俊林,高黎,黄晓东,等.416例鼻咽癌调强放疗远期生存与影响因素分析.中华放射肿瘤学杂志,2012,21:196-200.
[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,肖巍魏,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] Su SF, Han F, Zhao C, et al. Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy. Chin J Cancer,2011,30:565-573.
[9] Lin S, Lu JJ, Han L, et al. Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma:experience of 370 consecutive cases. BMC Cancer,2010,10:39.
[10] Tham IW, Hee SW, Yeo RM, et al. Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy-the national cancer centre Singapore experience. Int J Radiat Oncol Biol Phys,2009,75:1481-1486.
[11] Wang J, Shi M, Hsia Y, et al. Failure patterns and survival in patients with nasopharyngeal carcinoma treated with intensity modulated radiation in Northwest China:a pilot study. Radiat Oncol,2012,7:2.
[12] Ng WT, Lee MC, Hung WM, et al. Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys,2011,79:420-428.
[13] Fang FM, Chien CY, Tsai WL, et al. Quality of life and survival outcome for patients with nasopharyngeal carcinoma receiving three-dimensional conformal radiotherapy vs. intensity-modulated radiotherapy-a longitudinal study. Int J Radiat Oncol Biol Phys,2008,72:356-364.
[14] Zhao LN, Zhou B, Shi M, et al. Clinical outcome for nasopharyngeal carcinoma with predominantly WHO Ⅱ histology treated with intensity-modulated radiation therapy in non-endemic region of China. Oral Oncol,2012,48:864-869.
[15] Wu S, Xie C, Jin X, et al. Simultaneous modulated accelerated radiation therapy in the treatment of nasopharyngeal cancer:a local center′s experience. Int J Radiat Oncol Biol Phys,2006,66:40-46.
[16] Kwong D, Sham J, Choy D. The effect of loco-regional control on distant metastatic dissemination in carcinoma of the nasopharynx:An analysis of 1301 patients. Int J Radiat Oncol Biol Phys,1994,30:1029-1036.
[17] Nasr HB, Chahed K, Bouaouina N, et al. Functional vascular endothelial growth factor-2578 C/A polymorphism in relation to nasopharyngeal carcinoma risk and tumor progression. Clin Chim Acta,2008,395:124-129.