碳离子治疗IMRT后局部区域复发鼻咽癌初步研究——上海市质子重离子医院临床经验

doi:10.3760/cma.j.issn.1004-4221.2020.03.001

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摘要目的分析再程调强碳离子放疗(IMCT)对IMRT后局部区域复发鼻咽癌的疗效及不良反应。方法纳入112例于2015-2018年接受挽救性再程IMCT的局部区域复发鼻咽癌患者,Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为10例(9%)、26例(23%)、41例(37%)、35例(31%),中位年龄48岁(17~70岁),中位照射剂量为60GyE(50~69GyE)。结果中位随访20个月(5~45个月),共20例患者死亡,42例患者局部复发,2年总生存(OS)率与无局部进展生存(LPFS)率分别为85%与52%。单因素与多因素分析中Ⅳ期患者OS均显著差于其他患者,未发现与LPFS显著相关的预后因素。治疗期间未见≥3级急性不良反应。≥3级晚期不良反应包括1例口干、2例听力下降、1例大脑颞叶损伤与19例鼻咽黏膜坏死。结论再程IMCT治疗局部区域复发鼻咽癌取得了较好疗效且严重不良反应发生率较低,远期疗效及不良反应有待进一步随访。

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	胡集祎
	高晶
	胡微煦
	杨婧
	管西寅
	邱献新
	孔琳
	陆嘉德

关键词 ：鼻咽肿瘤/碳离子调强放疗, 再程放疗, 治疗结果

Abstract：Objective To evaluate the short-term efficacy and toxicities of intensity-modulated carbon ion radiotherapy (IMCT) for patients with locoregionally recurrent nasopharyngeal carcinoma after intensity-modulated radiotherapy (IMRT). Methods A total of 112 patients with locoregionally recurrent nasopharyngeal carcinoma undergoing salvaging IMCT between May 2015 and February 2018were enrolled in the study. All patients previously received one course of definitive X-ray IMRT. Among them,10 patients (9%) were diagnosed with stage Ⅰ,26 patients (23%) with stage Ⅱ,41 patients (37%) with stage Ⅲ and 35 patients (31%) with stage Ⅳnasopharyngeal carcinoma,respectively. The median age of the cohort was 48 years (range,17-70 years) old. The median dose to the gross tumor volume (GTV) was 60 GyE (range,50-69 GyE). Results With a median follow-up time of 20 months (range,5-45 months),20 patients died and 42 patients developed local recurrence. The 2-year overall survival (OS) and local progression-free survival (LPFS) rates were 85% and 52%. Both univariate and multivariate analyses demonstrated that stage Ⅳ disease was associated with significantly worse OS. No predictors were found for LPFS. No acute toxicity of grade 3 or higher was observed during reirradiation. Severe (grade 3 or above) late toxicities included xerostomia (n=1),hearing impairment (n=2),temporal lobe injury (n=1) and mucosal necrosis (n=19).Conclusions IMCT is an efficacious and safe treatment for patients with locoregionally recurrent nasopharyngeal carcinoma with acceptable toxicity profile. Long-term follow-up is necessary to further evaluate the long-term efficacy and late toxicities.

Key words： Nasopharyngeal neoplasm/intensity-modulated carbon ion radiotherapy Second-course radiotherapy Treatment outcome

收稿日期: 2019-03-15

基金资助:科技部数字诊疗装备研发(2017YFC0108603);上海浦东新区浦东新区科技发展基金民生项目(PKJ2016-Y41);上海市青年科技启明星计划(19QB1405500);上海浦东新区浦东新区科技发展基金民生项目(PKJ2017-Y51)

通讯作者: 孔琳,Email:lin.kong@sphic.org.cn;陆嘉德,Email:jiade.lu@sphic.org.cn

引用本文:

胡集祎,高晶,胡微煦等. 碳离子治疗IMRT后局部区域复发鼻咽癌初步研究——上海市质子重离子医院临床经验[J]. 中华放射肿瘤学杂志, 2020, 29(3): 161-165.

Hu Jiyi,Gao Jing,Hu Weixu et al. Preliminary study of intensity-modulated carbon ion reirradiation for locoregionally recurrent nasopharyngeal carcinoma after definitive IMRT——Clinical experience from Shanghai Proton Heavy Ion Hospital[J]. Chinese Journal of Radiation Oncology, 2020, 29(3): 161-165.

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