大分割三维适形放疗治疗鼻咽癌鼻咽复发再程放疗的不良反应及疗效评估

doi:10.3760/cma.j.issn.1004-4221.2019.03.003

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Abstract Objective To evaluate the clinical efficacy and safety of the hypofractionated three-dimensional conformal radiotherapy in the treatment of recurrent nasopharyngeal carcinoma. Methods Clinical data of 153 patients with recurrent nasopharyngeal carcinoma admitted to our hospital from 2008 to 2013 undergoing hypofractionated three-dimensional conformal radiotherapy (3 Gy for each time, 5 times a week, a total dose of 51-60 Gy, 17-20 times/4 weeks) were retrospectively analyzed. The short-and long-term radiation-induced injury, Karnofsky performance score (KPS), short-and long-term clinical efficacy were evaluated. Results For the short-term radiation-induced injury, the incidence of oral mucosa and fatigue significantly differed before and after treatment (both P<0.05). Regarding the long-term radiation-induced injury, the incidence of dry mouth (95.4%) and deafness (51.0%),difficulty in opening mouth (79.1%),maxillofacial fibrosis (33.3%) and radiation-induced encephalopathy (15.0%) significantly differed before and following treatment (all P<0.05). The actual long-term radiation-induced injury included dry mouth (91.5%), deafness (50.9%), difficulty in opening mouth (76.5%), maxillofacial fibrosis (32.0%) and radiation-induced encephalopathy (14.4%). The number of patients with changes in the KPS scores significantly differed between the end of treatment and 3 months after treatment (P<0.05). The local control rates were 29.4%, 68.6%, 79.1%, 83.7% and 86.9% at 1-, 3-, 6-, 9-and 12-month after corresponding treatment, respectively. The local control rate significantly differed between 1 and 3 months, and between 3 and 6 months after treatment (both P<0.05). The 1-, 2-, 3-, 4-and 5-year survival rates were calculated as 96.1%,80.4%,68.5%,57.9% and 51.1%,respectively. Conclusions Hypofractionated three-dimensional conformal radiotherapy is an efficacious and safe treatment of recurrent nasopharyngeal nasopharyngeal carcinoma, which yields relatively high short-and long-term clinical efficacy, high local control rate and well tolerance by the patients.

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	Articles by authors
	Long Bin
	Zhou Guanghua
	Yang Xinhui
	Shi Xiaoyan
	Long Jun

Key words： Nasopharyngeal neoplasm recurrence/three-dimensional conformal radiotherapy Radiotherapy, hypofractionated Radiation-induced injury Treatment outcome

Received: 29 May 2018

Corresponding Authors: Zhou Guanghua,Email:zghua0805@163.com

Cite this article:

Long Bin,Zhou Guanghua,Yang Xinhui et al. Clinical efficacy and safety of hypofractionated three-dimensional conformal radiotherapy in the treatment of recurrent nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2019, 28(3): 173-179.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2019.03.003 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2019/V28/I3/173

[1] 马涛,刘斌,刘丽霞,等.局部复发鼻咽癌调强放疗的临床结果和预后因素分析[J].河北医药,2016,38(14):2185-2187.DOI:10.3969/j.issn.1002-7386.2016.14.031.
Ma T,Liu B,Liu LX,et al. Clinical results and prognostic factors of intensity-modulated radiotherapy for locally recurrent nasopharyngeal carcinoma[J].Hebei Med J,2016,38(14):2185-2187.DOI:10.3969/j.issn.1002-7386.2016.14.031.
[2] Tian YM,Huang WZ,Yuan X,et al. The challenge in treating locally recurrent T3-4 nasopharyngeal carcinoma:the survival benefit and severe late toxicities of re-irradiation with intensity-modulated radiotherapy[J].Oncotarget,2017,8(26):43450-43457.DOI:10.18632/oncotarget.15896.
[3] 张慧慧,江浩,汪庚明,等.复发鼻咽癌的治疗进展[J].现代肿瘤医学,2017,25(12):2014-2018.DOI:10.3969/j.issn.1672-4992.2017.12.042.
Zhang HH,Jiang H,Wang GM,et al. Advanced research on treatment of recurrent nasopharyngeal carcinoma[J].J Mod Oncol,2017,25(12):2014-2018.DOI:10.3969/j.issn.1672-4992.2017.12.042.
[4] Tian YM,Guan Y,Xiao WW,et al. Long-term survival and late complications in intensity-modulated radiotherapy of locally recurrent T1 to T2 nasopharyngeal carcinoma[J].Head Neck,2016,38(2):225-231.DOI:10.1002/hed.23880.
[5] Wambersie A,Landberg T.ICRU report 62:prescribing,recording and reporting photon beam therapy (Supplement to ICRU Report 50)[J].J ICRU,1999,32(1):1-7.
[6] Lee N,Harris J,Garden AS,et al. Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma:radiation therapy oncology group phase Ⅱ trial 0225[J].J Clin Oncol,2009,27(22):3684-3690.DOI:10.1200/JCO.2008.19.9109.
[7] Tian YM,Zhao C,Guo Y,et al. Effect of total dose and fraction size on survival of patients with locally recurrent nasopharyngeal carcinoma treated with intensity-modulated radiotherapy:a phase 2,single-center,randomized controlled trial[J].Cancer,2014,120(22):3502-3509.DOI:10.1002/cncr.28934.
[8] 阳秋香,张秀萍,李果,等.复发鼻咽癌的预后因素分析[J].中华肿瘤防治杂志,2015,22(15):1211-1214.DOI:10.16073/j.cnki.cjcpt.2015.15.012.
Yang QX,Zhang XP,Li G,et al. Prognostic analysis of recurrent nasopharyngeal carcinoma[J].Chinese Journal of Cancer Prevention and Treatment,2015,22(15):1211-1214.DOI:10.16073/j.cnki.cjcpt.2015.15.012.
[9] Zhao L,Tang M,Hu Z,et al.miR-504 mediated down-regulation of nuclear respiratory factor 1 leads to radio-resistance in nasopharyngeal carcinoma[J].Oncotarget,2015,6(18):15995-6018.DOI:10.18632/oncotarget.4138.
[10] 中国抗癌协会鼻咽癌专业委员会,李金高,陈晓钟,等.鼻咽癌复发、转移诊断专家共识[J].中华放射肿瘤学杂志,2018(1):7-15.DOI:10.3760/cma.j.issn.1004-4221.2018.01.002.
China Anti-Cancer Association Nasopharyngeal Carcinoma Professional Committee,Li JG,Chen XZ,et al. Expert consensus on the diagnosis of recurrent or metastatic nasopharyngeal carcinoma[J].Chin J Radiat Oncol,2018(1):7-15.DOI:10.3760/cma.j.issn.1004-4221.2018.01.002.
[11] 中国抗癌协会鼻咽癌专业委员会,林少俊,陈晓钟,等.复发鼻咽癌治疗专家共识[J].中华放射肿瘤学杂志,2018(1):16-22.DOI:10.3760/cma.j.issn.1004-4221.2018.01.004.
China Anti-Cancer Association Nasopharyngeal Carcinoma Professional Committee,Lin SJ,Chen XZ,et al. Expert consensus on the treatment of recurrent nasopharyngeal carcinoma[J].Chin J Radiat Oncol,2018(1):16-22.DOI:10.3760/cma.j.issn.1004-4221.2018.01.004.
[12] Teckie S,Lok BH,Rao S,et al. High-dose hypofractionated radiotherapy is effective and safe for tumors in the head-and-neck[J].Oral Oncol,2016,60:74-80.DOI:10.1016/j.oraloncology.2016.06.016.
[13] Lee VH,Kwong DL,Leung TW,et al. Hyperfractionation compared to standard fractionation in intensity-modulated radiation therapy for patients with locally advanced recurrent nasopharyngeal carcinoma[J].Eur Arch Otorhinolaryngol,2017,274(2):1067-1078.DOI:10.1007/s00405-016-4339-0.
[14] 尹丽,郭文杰,解鹏,等.局部复发鼻咽癌超分割IMRT的临床分析[J].中华放射肿瘤学杂志,2016,25(9):917-922.DOI:10.3760/cma.j.issn.1004-4221.2016.09.02.
Yin L,Guo WJ,Jie P,et al. Efficacy of intensity-modulated radiotherapy on patients with locally recurrent nasopharyngeal carcinoma[J].Chin J Radiat Oncol,2016,25(9):917-922.DOI:10.3760/cma.j.issn.1004-4221.2016.09.02.
[15] Deantonio L,Cozzi S,Tunesi S,et al. Hypofractionated radiation therapy for breast cancer:long-term results in a series of 85 patients[J].Tumori,2016,102(4):398-403.DOI:10.5301/tj.5000511.
[16] 张秋琪,汪延明.射波刀与大分割三维适形放疗治疗原发性肝癌的疗效比较[J].解放军医学院学报,2016,37(8):819-822.DOI:10.3969/j.issn.2095-5227.2016.08.001.
Zhang QQ,Wang YM.Clinical efficacy of cyberknife versus hypofractionated three dimensional conformal radiotherapy in hepatocellular carcinoma:a comparative study[J].Acad J Chin Pla Med School,2016,37(8):819-822.DOI:10.3969/j.issn.2095-5227.2016.08.001.
[17] Nguyen NA,Isfahanian N,Pond G,et al. A novel neoadjuvant therapy for operable locally invasive non-small-cell lung cancer.phase Ⅰ study of neoadjuvant stereotactic body radiotherapy. LINNEARRE I (NCT02433574)[J].Clin Lung Cancer,2017.18(4):436-440.DOI:10.1016/j.cllc.2017.01.007.
[18] 刘军华.大分割放疗联合替莫唑胺治疗大体积脑转移瘤的效果观察[J].实用癌症杂志,2017(11).1814-1816,1823.DOI:10.3969/j.issn.1001-5930.2017.11.022.
Liu JH.Observation of the effect of large fractionated radiotherapy combined with temozolomide for large volume brain metastases[J].Practical J Cancer,2017(11).1814-1816,1823.DOI:10.3969/j.issn.1001-5930.2017.11.022.
[19] 吴迪,白志军,李尚鑫.大分割和常规分割放疗对骨转移瘤疼痛的疗效研究[J].慢性病学杂志,2017(9):966-968.DOI:10.16440/j.cnki.1674-8166.2017.09.005.
Wu D,Bai ZJ,Li SX,et al. Therapeutic effect of large segmentation and conventional segmentation radiotherapy on bone metastases pain[J].Chron Pathematol J,2017(9):966-968.DOI:10.16440/j.cnki.1674-8166.2017.09.005.
[20] 汤轶强,黄敏,龚晓昌,等.三维适形放射后程大分割治疗鼻咽癌的近期疗效分析[J].中国全科医学,2013,16(5):553-555.DOI:10.3969/j.issn.1007-9572.2013.02.063.
Tang YQ,Huang M,Gong XC,et al. Short-term effect of late-course hypofractionated 3D CRT in patients with pimary nasopharyngeal carcinoma[J].Chin General Pract,2013,16(5):553-555.DOI:10.3969/j.issn.1007-9572.2013.02.063.
[21] Moon SH,Cho KH,Lee CG,et al. IMRT vs. 2D-radiotherapy or 3D-conformal radiotherapy of nasopharyngeal carcinoma:survival outcome in a Korean multi-institutional retrospective study (KROG 11-06)[J].Strahlenther Onkol,2016,192(6):377-385.DOI:10.1007/s00066-016-0959-y.
[22] 赵海鹰,李思维.复发鼻咽癌综合治疗及其进展[J].实用医学杂志,2018,34(05):691-697.DOI:10.3969/j.issn.1006-5725.2018.05.001.
Zhao HYg,Li SW.Comprehensive treatment of recurrent nasopharyngeal carcinoma and its progress[J].J Pract Med,2018,34(05):691-697.DOI:10.3969/j.issn.1006-5725.2018.05.001.
[23] Kong L,Wang L,Shen C,et al. Salvage intensity-modulated radiation therapy (IMRT) for locally recurrent nasopharyngeal cancer after definitive IMRT:a novel sScenario of the modern era[J].Sci Rep,2016,6(2S):E329.DOI:10.1038/srep32883.
[24] Xiao WW,Liu S,Tian YM,et al. Prognostic significance of tumor volume in locally recurrent nasopharyngeal carcinoma treated with salvage intensity-modulated radiotherapy[J].Plos One,2015,10(4):e0125351-0125351.DOI:10.1371/journal.pone.0125351.
[25] Kong L,Wang L,Shen C,et al. Salvage Intensity modulated radiation therapy (IMRT) for locally recurrent nasopharyngeal cancer after definitive IMRT:treatment outcomes of a clinically distinct condition in the modern era[J].Int J Radiat Oncol Biol Phys,2016,96(2S):E329-E329.DOI:10.1016/j.ijrobp.2016.06.1456.
[26] Hong YT,Hong KH.Sequential occurrence of diffuse large B-cell lymphoma and carcinoma in the nasopharynx:a case report[J].Medicine,2018,97(2):e9595-9595.DOI:10.1097/MD.0000000000009595.
[27] 贺琴,吴府容,邱大,等.81例复发鼻咽癌的临床特征及预后因素分析[J].重庆医学,2016,45(24):3402-3404.DOI:10.3969/j.issn.1671-8348.2016.24.030.
He Q,Wu FR,Qiu D,et al. Clinical characteristics and prognostic factors of 81 patients with recurrent nasopharyngeal carcinoma[J].Chongqing Med,2016,45(24):3402-3404.DOI:10.3969/j.issn.1671-8348.2016.24.030.
[28] 林灿峰,李东升,林柏翰,等.鼻咽癌治疗后局部复发回顾性研究[J].中华肿瘤防治杂志,2017,24(3):188-191.DOI:10.16073/j.cnki.cjcpt.2017.03.009.
Lin CF,Li S,Lin BH,et al. Distant metastasis of nasopharyngeal carcinoma after treatment:A 15-year follow-up study[J].Chin J Cancer Prevent Treat,2017,24(3):188-191.DOI:10.16073/j.cnki.cjcpt.2017.03.009.
[29] 龙斌,刘利民,周光华,等.帕洛诺司琼联合地塞米松在复发鼻咽癌放疗中顺铂增敏所致恶心呕吐的作用[J].山西医药杂志,2018,47(12):1370-1373. DOI:10.3969/j. Issn.0253-9926.2018.12.00.
Long B,Liu LM,Zhou GH,et al. The effect of palonosetron combined with dexamethasone on nausea and vomiting induced by cisplatin sensitization in radiotherapy for recurrent nasopharyngeal carcinoma[J].Shanxi Medical Journal,2018,47(12):1370-1373.DOI:10.3969/j. Issn.0253-9926.2018.12.00.
[30] Zhang L,Huang Y,Hong S,et al. Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma:a multicentre,randomised,open-label,phase 3 trial[J].Lancet,2016,388(10054):1883-1892.DOI:10.1016/S0140-6736(16)31388-5.
[31] Kong L,Lu JJ.Reirradiation of locally recurrent nasopharyngeal cancer:history,advances,and promises for the future[J].Chin Clin Oncol,2016,5(2):26-26.DOI:10.21037/cco.2016.03.19.
[32] Sun Y,Li WF,Chen NY,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.
[33] Lan XW,Zou XB,Yao X,et al. Retrospective analysis of the survival benefit of induction chemotherapy in stage Ⅳ a-b nasopharyngeal carcinoma[J].Plos One,2016,11(8):e0160758-0160758.DOI:10.1371/journal.pone.0160758.