132例鼻咽癌调强放疗长期生存及晚期损伤分析

doi:10.3760/cma.j.cn113030-20200915-00468

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Abstract Objective To retrospectively analyze the long-term survival (10-15 years) and late toxicity of nasopharyngeal carcinoma (NPC) patients after intensity-modulated radiotherapy (IMRT), aiming to provide reference for the optimal treatment of NPC. Methods 132 patients with NPC who were treated with IMRT in Sichuan Cancer Hospital from 2003 to 2009 were recruited. Among them, 3 patients were classified as stage Ⅰ, 22 cases of grade Ⅱ, 61 cases of grade Ⅲ, 43 cases of ⅣA and 3 cases of ⅣB, respectively. The median dose was 73.37Gy (66 to 85Gy), divided into 33 times. Twenty patients received radiotherapy alone, 112 cases of concurrent radiochemotherapy. The survival rate was calculated by Kaplan-Meier method and log-rank test. Univariate prognostic analysis was performed. Cox model was used to conduct multivariate prognostic analysis. The late radiation toxicity was evaluated by RTOG/EORTC criteria. Results The median follow-up duration was 128 months (range, 3 to 191 months). The 10-and 15-year local control rates of NPC patients were 86.0% and 79.9%. The disease-free survival rates were 72.5% and 63.2%, and the overall survival (OS) rates were 65.2% and 57.1%. The local recurrence rate was 12.1%, and the distant metastasis rate was 16.7%. A total of 53 patients died, of whom 15 patients died of local recurrence, 20 patients died of distant metastasis and 18 patients died of other diseases (pneumonia, intracranial hemorrhage and accident, etc.). The 10-and 15-year non-tumor-related mortality rates were 11.3% and 13.6%. Univariate analysis showed that age, smoking habit, lactate dehydrogenase (LDH), T stage and clinical stage were the independent prognostic factors of OS in NPC patients. Multivariate analysis demonstrated that LDH, T stage and synchronous chemotherapy were the prognostic factors of OS in NPC patients. The incidence of gradeⅠ-Ⅱ late radiation injury (hearing impairment, dysphagia, dental caries and xerostomia) was 90.4%,and 8.5% for grade Ⅲ-Ⅳ late radiation injury (skin fibrosis, hearing impairment and radiation brain injury). Conclusions The 10-and 15-year OS of NPC patients treated with IMRT is relatively high. With the prolongation of survival, the non-tumor-related mortality rate is increased. Distant metastasis is the main cause of treatment failure. The main late injuries include grade Ⅰ/Ⅱ hearing impairment, dysphagia, dental caries and xerostomia.

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	Articles by authors
	Fang Zengyi
	Wu Zifei
	Wu Chuan
	Luo Cheng
	Gao Mingquan
	Lai Xin
	Luo Liping
	Wang Weidong
	Lang Jinyi

Key words： Nasopharyngeal neoplasm/intensity-modulated radiotherapy Prognosis Late radiation injury

Received: 15 September 2020

Fund:National Key Research & Development Program (2017YFC0113904);Sichuan Key Research & Development Project (2017SZ0004)

Corresponding Authors: Wang Weidong, Email:wwdwyl@sina.com;Lang Jinyi, Email:Langjy610@163.com

Cite this article:

Fang Zengyi,Wu Zifei,Wu Chuan et al. Analysis of long-term survival outcomes and late radiation toxicity of 132 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J]. Chinese Journal of Radiation Oncology, 2021, 30(7): 653-658.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20200915-00468 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2021/V30/I7/653

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