A prospective, multicentric clinical study of intensity modulated radiotherapy in the treatment of nasopharyngeal carcinoma
WU Fang*, WANG Ren-sheng, FENG Guo-sheng, LI Gui-sheng, LIU Mei-lian, YAN Hao-lin, ZHU Jin-xian, ZHANG Yong, HU Kai
*Department of Radiotherapy, First Affiliated Hospital of Guangxi Medical University, Nanning 530021,China Corresponding author:WANG Ren-sheng, Email:wrsgx@yahoo.com.cn
Abstract：Objective To evaluate the treatment efficacy, toxicities and prognostic factors ofnasopharyngeal carcinoma (NPC) treated with intensity modulated radiation oncology (IMRT).MethodsBetween January 2006 and August 2008, 300 patients with pathologically diagnosed NPC from 6 center received IMRT. The number of patients with stageⅠ, Ⅱ, Ⅲ and Ⅳa+b disease (UICC/AJCC 2002 staging system) were 6, 45,141 and 108, respectively. The prescription doses were as follows:70－74 Gy/30f to planning target volume of primary nasopharynx tumor (PTVnx), 68－70 Gy/30f to planning target volume of positive lymphnode (ptvnd), 60－64 Gy/30f to higher risk region (PTV1), 50－54 Gy/30f to lower risk region (PTV2). Patients with stage Ⅲ and Ⅳa+b disease also received cisplatin-based chemotherapy. Cox method was used for Multivariate analysis. Results The follow-up rate was 99.7%. The 4-year rate of local control, regional control, metastasis-free survival (DMFS),disease-free survival (DFS) and overall survival (OS) was 94.0%, 95.5%, 87.4%, 80.8%, 86.1%, respectively. Mucositis was the most severe acute toxicity, with 18.0% grade 1, 48.7% grade 2, 33.3% grade 3. No patient suffered from grade 4 mucositis. Xerostomia was the most common late toxicity, with 12.0% grade 0, 75.7% grade 1, 12.3% grade 2. No grade 3－4 xerostomia was observed. There were 18,15 and 42 patients failed in local, regional and distant metastasis, respectively. Multivariate analysis showed that N stage was the only prognostic factor for OS (χ2=5.17,P=0.023),DMFS (χ2=6.91,P=0.009) and DFS (χ2=8.15,P=0.004) in these patients. Conclusions IMRT can improve the treatment efficacy of NPC. The acute and late toxicities were tolerated. Distant metastasis becomes the main treatment failure. N stage is a significant prognostic factors.
WU Fang*,WANG Ren-sheng,FENG Guo-sheng et al. A prospective, multicentric clinical study of intensity modulated radiotherapy in the treatment of nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2012, 21(5): 407-410.
[1] 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. [2] Hunt MA, Zelefsky MJ, Wolden S, et al. Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer．Int J Radiat Oncol Biol Phys,2001,49:623-632． [3] Cheng JCH, Chao KSC, Low D．Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma．Int J Cancer,2001,96:126-131． [4] Radiation Therapy Oncology Group Protocol 02－25[2012-03-20].http://www.rtog.org/members/protocols/0225/0225.pdf. [5] Emami B, Sethi A, Petruzzelli GJ,et al. Influence of MRI on target volume delineation and IMRT planning in nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys,2003,57:481-488. [6] Kam MK, Chau RM, Suen J, et al. Intensity-modulated radiotherapy in nasopharyngeal carcinoma:dosimetric advantage over conventional plans and feasibility of dose escalation. Int J Radiat Oncol Biol Phys,2003,56:145-157. [7] Cozzi L, Fogliata A, Bolsi A,et al. Three-dimensional conformal vs. intensity-modulated radiotherapy in head-and-neck cancer patients:comparative analysis of dosimetric and technical parameters. Int J Radiat Oncol Biol Phys,2004,58:617-624. [8] Levendag PC, Lagerwaard FJ, de Pan C,et al. High-dose, high-precision treatment options for boosting cancer of the nasopharynx. Radiother Oncol,2002,63:67-74. [9] Kwong DL, Pow EH, Sham JS, et al. Intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma:a prospective study on disease control and preservation of salivary function. Cancer,2004,101:1584-1593. [10] Lee N, Xia P, Quivey JM, et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:an update of the UCSF experience. Int J Radiat Oncol Biol Phys,2002,53:12-22. [11] Xiao WW, Huang SM, Han F,et al. Local control, survival, and late toxicities of locally advanced nasopharyngeal carcinoma treated by simultaneous modulated accelerated radiotherapy combined with cisplatin concurrent chemotherapy:long-term results of a phase 2 study. Cancer,2011,117:1874-1883. [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.中华放射肿瘤学杂志,2010,19:191-196. [13] Wolden SL, Chen WC, Pfister DG, et al. Intensity-modulatedradiation therapy (IMRT) for nasopharynx cancer:update of the
Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys,2006,64:57-62. [14] Talmi YP, Horowitz Z, Bedrin L, et al．Quality of life of nasopharyngeal carcinoma patients．Cancer,2002,94:1012-1017. [15] 韩露,林少俊,潘建基,等.305例鼻咽癌调强放疗预后因素分析.癌症,2010,29:153-158. [16] 高云生,胡超苏,应红梅,等.1837例鼻咽癌疗效的回顾性分析.中华放射肿瘤学杂志,2008,17:335-339.
2012, Vol. 21 
