Abstract：Objective To retrospectively analyze the characteristics of nasopharyngeal carcinoma, long-term efficacy, adverse reactions of intensity-modulated radiotherapy (IMRT) in non-endemic northwest China and summarize the experience of IMRT in the treatment of nasopharyngeal carcinoma in the past decade. Methods Clinical data of 658 patients newly diagnosed with nasopharyngeal carcinoma without distant metastasis admitted to First affiliated hospital from January 2006 to December 2016 were retrospectively analyzed. All patients were treated with IMRT. The survival analysis was performed by Kaplan-Meier method. The multivariate analysis was conducted with Cox’s regression model. Results In non-endemic northwest China, a large proportion of patients were newly diagnosed with locally advanced nasopharyngeal carcinoma, and a majority of them were pathologically characterized as differentiated subtypes. The 5-year overall survival (OS),disease-free survival (DFS),local recurrence-free survival (LRFS),regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates were 75.7%,70.1%,91.2%,97.0% and 81.0%, respectively. Multivariate analysis showed that age, pathological type, nasopharyngeal tumor volume>23 cm3 and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DFS (all P<0.05). Age, pathological type, neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of OS (all P<0.05). N stage and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DMFS (both P<0.05). Conclusions Similar clinical efficacy has been achieved in terms of IMRT for nasopharyngeal carcinoma in non-endemic northwest China compared with that in endemic area. Induction chemotherapy combined with concurrent radiochemotherapy can provide clinical benefits for patients with locally advanced nasopharyngeal carcinoma in non-endemic area.
Xu Man,Shi Mei,Zang Jian et al. Long-term efficacy and adverse reactions of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma in non-endemic northwest China[J]. Chinese Journal of Radiation Oncology, 2020, 29(2): 81-87.
[1] 黄腾波,陈德林,张锦明,等. 中国南北方鼻咽癌发病危险因素对比研究[J]. 癌症,1997(5):6-9.
Huang TB,Chen DL,Zhang JM,et al. A comparative study on the risk factors of nasopharyngeal carcinoma in north and south China[J]. Chin J Cancer,1997(5):6-9.
[2] Yeh S,TangY,Lui C,et al. Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone[J]. Int J Radiat Oncol Biol Phys,2005,62(3):672-679. DOI:10.1016/j.ijrobp.2004.11.002.
[3] Tuan JKL,Ha TC,Ong WS,et al. Late toxicities after conventional radiation therapy alone for nasopharyngeal carcinoma[J]. Radiother Oncol,2012,104(3):305-311. DOI:10.1016/j.radonc.2011.12.028.
[4] Lee AWM,Ng WT,Chan LLK,et al. Evolution of treatment for nasopharyngeal cancer-Success and setback in the intensity-modulated radiotherapy era[J]. Radiother Oncol,2014,110(3):377-384. DOI:10.1016/j.radonc.2014.02.003.
[5] Wang W,Feng M,Fan Z,et al. Clinical outcomes and prognostic factors of 695 nasopharyngeal carcinoma patients treated with intensity-Modulated radiotherapy[J]. BioMed Res Int,2014(1):1-10. DOI:10.1155/2014/814948.
[6] Sun X,Su S,Chen C,et al. Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma:an analysis of survival and treatment toxicities[J]. Radiother Oncol,2014,110(3):398-403. DOI:10.1016/j.radonc.2013.10.020.
[7] Peng G,Wang T,Yang K,et al. Aprospective,randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs.conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma[J]. Radiother Oncol,2012,104(3):286-293. DOI:10.1016/j.radonc.2012.08.013.
[8] Ou X,Zhou X,Shi Q,et al. Treatment outcomes and late toxicities of 869 patients with nasopharyngeal carcinoma treated with definitive intensity modulated radiation therapy:new insight into the value of total dose of cisplatin and radiation boost[J]. Oncotarget,2015,6(35):38381. DOI:10.18632/oncotarget.5420.
[9] Zeng L,Tian Y,Sun X,et al. Intensity-modulated radiotherapy for stage IVA/IVB nasopharyngeal carcinoma[J]. StrahlentherOnkol,2014,190(11):993-1000.DOI:10.1007/s00066-014-0680-7.
[10] 区晓敏,史琪,周鑫,等.鼻咽癌IMRT远期疗效和不良反应分析[J]. 中华放射肿瘤学杂志,2016(4):304-309. DOI:10.3760/cma.j.issn.1004-4221.2016.04.002
Ou XM,Shi Q,Zhou X,et al. Long-term efficacy and adverse effects of intensity-modulated radiotherapy for nasopharyngeal carcinoma[J]. Chin J Radiat Oncol,2016,25(4):304-309. DOI:10.3760/cma.j.issn.1004-4221.2016.04.002.
[11] 臧健,许曼,赵丽娜,等.鼻咽部肿瘤体积在中国西北非高发区鼻咽癌患者中的预后价值[J]. 西安交通大学学报(医学版),2017(1):117-121. DOI:10.7652/jdyxb201701025.
Zang J,Xu M,Zhao LN,et al. The prognostic value of primary tumor volume in non-endemic patients with nasopharynx carcinoma in northwest China[J]. J Xi′an Jiaotong Univ (Med Sci).2017(1):117-121. DOI:10.7652/jdyxb201701025.
[12] 赵充,肖巍魏,韩非,等.419例鼻咽癌患者调强放疗疗效和影响[J]. 中华放射肿瘤学杂志,2010(3):191-196. DOI:10.3760/cma.j.issn.1004-4221.2010.03.005.
Zhao C,Xiao WW,Han F,et al. Long-term outcomeand prognostic factors of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy[J]. Chin J Radiat Oncol,2010(3):191-196. DOI:10.3760/cma.j.issn.1004-4221.2010.03.005.
[13] 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[J]. Radiat Oncol,2012,7(1):2. DOI:10.1186/1748-717X-7-2.
[14] Zhao L,Zhou B,Shi M,et al. Clinicaloutcome for nasopharyngeal carcinoma with predominantly WHO Ⅱ histology treated with intensity-modulated radiation therapy in non-endemic region of China[J]. Oral Oncol,2012,48(9):864-869. DOI:10.1016/j.oraloncology.2012.03.001.
[15] 罗山泉,石梅,王建华,等. 中国西北地区早期鼻咽癌调强放疗联合化疗的临床研究[J]. 中华放射肿瘤学杂志,2012,21(4):302-305. DOI:10.3760/cma.j.issn.1004-4221.2012.04.003.
Luo SQ,Shi M,Wang JH,et al. Intensity-modulated radiotherapy combined with chemotherapy for early-stage nasopharyngeal carcinoma patients in northwest China[J]. Chin J Radiat Oncol,2012,21(4):302-305. DOI:10.3760/cma.j.issn.1004-4221.2012.04.003.
[16] Zhao L,Xu M,Jiang W,et al. Induction chemotherapy for the treatment of non-endemic locally advanced nasopharyngeal carcinoma[J]. Oncotarget,2016,8(4):6763-6774. DOI:10.18632/oncotarget.14279.
[17] Blanchard P,Lee A,Marguet S,et al. Chemotherapy and radiotherapy in nasopharyngeal carcinoma:an update of the MAC-NPC meta-analysis[J]. Lancet Oncol,2015,16(6):645-655. DOI:10.1016/S1470-2045(15)70126-9.
[18] Sun Y,Li W,Chen N,et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:a phase 3,multicentre,randomised controlled trial[J]. Lancet Oncol,2016,17(11):1509-1520. DOI:10.1016/S1470-2045(16)30410-7.
[19] 龙金华,金风,吴伟莉,等.454例鼻咽癌IMRT±化疗远期疗效及影响因素分析[J]. 中华放射肿瘤学杂志,2015,24(6):659-662. DOI:10.3760/cma.j.issn.1004-4221.2015.06.012.
Long JH,Jin F,Wu WL,et al. Long-term efficacy of intensity-modulated radiotherapy with or without chemotherapy in treatment of nasopharyngeal carcinoma and its influencing factors:an analysis of 454 patients[J]. Chine J Radiat Oncol,2015,24(6):659-662. DOI:10.3760/cma.j.issn.1004-4221.2015.06.012.
[20] 周彬,石梅,王建华,等.中国西北地区133例鼻咽癌调强放疗的预后分析[J]. 中华放射肿瘤学杂志,2011,20(5):374-378. DOI:10.3760/cma.j.issn.1004-4221.2011.05.004.
Zhou B,Shi M,Wang JH,et al. Prognosis analyses of 133 nasopharyneal carcinona from northwest China treated by intensitymodulated radiotherapy[J]. Chin J Radiat Oncol,2011,20(5):374-378. DOI:10.3760/cma.j.issn.1004-4221.2011.05.004.
2020, Vol. 29 
