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基于调强放疗N0期鼻咽癌颈部预防照射的选择
曾雷, 陈春燕, 孙学明, 韩非, 邓小武, 卢泰祥
510060 广州,华南肿瘤学国家重点实验室 中山大学肿瘤防治中心放疗科
Volume of prophylactic irradiation to neck for stage N0 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy
ZENG Lei, CHEN Chun-yan, SUN Xue-ming, HAN Fei, DENG Xiao-wu, LU Tai-xiang
Department of Radiation Oncology, Cancer Center of Sun Yat-Sen University,State Key Laboratory of Oncology in Southern China, Guangzhou 510060,ChinaCorresponding author:LU Tai-xiang,Email:lutx@mail.sysu.edu.cn
Abstract：Objective To investigate the volume of prophylactic irradiation to the neck for stage N0 nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT). MethodsRetrospective analysis was performed on the clinical records of 270 patients with stage N0 NPC (based on the 6th version of AJCC/UICC staging system), who underwent IMRT as the initial treatment in our center from 2003 to 2008. Among all the patients, 171 received prophylactic upper-neck irradiation, and 99 prophylactic whole-neck irradiation. All of them received 6-MV X-ray IMRT to the primary focus of NPC and the lymphatic drainage area in the upper neck (Levels Ⅱ, Ⅲ, and ⅤA lymph nodes) at doses of 68 Gy/30 fractions and 54 Gy/30 fractions over 6 weeks. In addition, the patients receiving prophylactic whole-neck irradiation had the lower neck and supraclavicular fossae treated by anterior neck semi-field conventional technique at a dose of 50 Gy/25 fractions. Results The median follow-up was 65.1 months (range 4—106 months), and the follow-up rate was 93%. The patients undergoing prophylactic upper-neck irradiation and prophylactic whole-neck irradiation had 5-year disease specific survival rates of 95.3% and 91.9%(χ2=0.76,P=0.384), relapse-free survival rates of 99.4% and 99.0%(χ2=1.18,P=0.278), and distant metastasis-free survival rates of 98.8% and 94.9%(χ2=2.31,P=0.128). The 5-year distant metastasis-free survival rate was significantly higher in patients without retropharyngeal lymph node (RLN) metastasis than in those with RLN metastasis (99.4% vs. 93.7%, χ2=8.96,P=0.003). Grade 1—2 mucositis and pharyngitis were the most common acute adverse reactions in patients. At 24 months after IMRT, no grade 3 or 4 xerostomia and trismus were developed. Conclusions Prophylactic irradiation to the upper neck may be feasible for stage N0 NPC patients treated with IMRT. It is reasonable in the 7th version of AJCC/UICC staging system that NPC with negative cervical lymph nodes and positive RLNs is reclassified to stage N1.
ZENG Lei,CHEN Chun-yan,SUN Xue-ming et al. Volume of prophylactic irradiation to neck for stage N0 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J]. Chinese Journal of Radiation Oncology, 2013, 22(2): 133-138.
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