IMRT同期化疗在Ⅲ期鼻咽癌中作用分析

doi:10.3760/cma.j.cn113030-20190520-00186

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To investigate the clinical efficacy of concurrent chemotherapy in intensity-modulated radiotherapy (IMRT) for patients with stage Ⅲ nasopharyngeal carcinoma (NPC). Methods Clinical data of 251 patients with stage Ⅲ NPC treated with IMRT alone or concurrent chemoradiotherapy (CCRT) at Sun Yat-sen University Cancer Center from February 2001 to December 2008 were retrospectively analyzed. The prognostic factors of NPC were analyzed and the efficacy of CCRT was assessed. The survival rate was calculated by Kaplan-Meier method. The differences between two groups were analyzed by log-rank test. The prognostic factors were analyzed by Cox model. Results The 10-year locoregional-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) for NPC patients were 88.6%, 81.1%, 68.8% and 75.1%, respectively. Univariate and multivariate analyses demonstrated that N staging and nasopharyngeal tumor volume were the most important prognostic factors, and concurrent chemotherapy significantly improved PFS and OS (both P<0.05). In T3N0-1 patients, there was no significant difference in survival indexes between IMRT alone and CCRT (10y-LRFS:93.8% vs. 93.2%, P=0.933;10y-DMFS:80.9% vs. 86.8%, P=0.385;10y-PFS:70.6% vs. 77.7%, P=0.513;10y-OS:71.8% vs. 83.6%, P=0.207). For T1-3N2 patients, CCRT was significantly better than radiotherapy alone in LRFS, PFS, and OS (10y-LRFS:87.3% vs. 66.7%, P=0.016;10y-PFS:70.2% vs. 41.0%, P=0.003;10y-OS:78.5% vs. 51.7%, P=0.008), whereas there was an increasing trend in DMFS (10y-DMFS:80.3% vs. 66.4%, P=0.103). Conclusions Concurrent chemotherapy can improve clinical prognosis of stage Ⅲ NPC patients, and the most survival benefits are obtained in the N2 group. Individualized treatment options should be delivered based on the risk of treatment failure.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Wu Zheng
	Wang Lei
	Xie Dehuan
	Lyu Shaowen
	Su Yong

Key words： Nasopharyngeal neoplasm/intensity-modulated radiotherapy Nasopharyngeal neoplasm/concurrent radiochemotherapy Prognosis

Received: 20 May 2019

Corresponding Authors: Su Yong, Email:suyong@sysucc.org.cn

Cite this article:

Wu Zheng,Wang Lei,Xie Dehuan et al. The role of concurrent chemotherapy in intensity-modulated radiotherapy for patients with stage Ⅲ nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2020, 29(10): 827-832.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20190520-00186 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2020/V29/I10/827

[1] 李晔雄. 肿瘤放疗学[M].5版. 北京:中国协和医科大学出版社, 2018:389-446.
Li YX. Tumor radiotherapy[M].5^th ed. Beijing:Peking Union Medical College Press, 2018:389-446.
[2] Chua MLK, Wee JTS, Hui EP, et al. Nasopharyngeal carcinoma[J]. Lancet, 2016, 387(10022):1012-1024. DOI:10.1016/S0140-6736(15)00055-0.
[3] Lee N, Xia P, Quivey JM, et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:an update of the UCSF experience[J]. Int J Radiat Oncol Biol Phys, 2002, 53(1):12-22. DOI:10.1016/s0360-3016(02)02724-4.
[4] Wolden SL, Chen WC, Pfister DG, et al. Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer:update of the Memorial Sloan-Kettering experience[J]. Int J Radiat Oncol Biol Phys, 2006, 64(1):57-62. DOI:10.1016/j.ijrobp.2005.03.057.
[5] 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, 2010,19(3):191-196. DOI:10.3760/cma.j.issn.1004-4221.2010.03.005.
Zhao C, Xiao WW, Han F, et al. Long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy[J]. Chin J Radiat Oncol, 2010, 19(3):191-196. DOI:10.3760/cma.j.issn.1004-4221.2010.03.005.
[6] Kam MK, Teo PML, Chau RMC, et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy:the Hong Kong experience[J]. Int J Radiat Oncol Biol Phys, 2004, 60(5):1440-1450. DOI:10.1016/j.ijrobp.2004.05.022.
[7] Wu LR, Liu YT, Jiang N, et al. Ten-year survival outcomes for patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy:an analysis of 614 patients from a single center[J]. Oral Oncol, 2017, 69(1):26-32. DOI:10.1016/j.oraloncology.2017.03.015.
[8] Langendijk JA, Leemans CR, Buter J, et al. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma:a meta-analysis of the published literature[J]. J Clin Oncol, 2004, 22(22):4604-4612. DOI:10.1200/jco.2004.10.074.
[9] Baujat B, Audry H, Bourhis J, et al. Chemotherapy in locally advanced nasopharyngeal carcinoma:an individual patient data meta-analysis of eight randomized trials and 1753 patients[J]. Int J Radiat Oncol Biol Phys, 2006, 64(1):47-56. DOI:10.1016/j.ijrobp.2005.06.037.
[10] 易俊林, 高黎, 黄晓东, 等. 416例鼻咽癌调强放疗远期生存与影响因素分析[J]. 中华放射肿瘤学杂志, 2012,21(3):196-200. DOI:10.3760/cma.j.issn.1004-4221.2012.03.002.
Yi JL, Gao L, Huang XD, et al. Nasopharyngeal carcinoma treated by intensity-modulated radiotherapy:long-term results of 416 patients[J]. Chin J Radiat Oncol, 2012,21(3):196-200. DOI:10.3760/cma.j.issn.1004-4221.2012.03.002.
[11] 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.
[12] Au KH, Ngan RKC, Ng AWY, et al. Treatment outcomes of nasopharyngeal carcinoma in modern era after intensity modulated radiotherapy (IMRT) in Hong Kong:A report of 3328 patients (HKNPCSG 1301 study)[J]. Oral Oncol, 2018, 77(1):16-21. DOI:10.1016/j.oraloncology.2017.12.004.
[13] International Commission on Radiation Units and Measurements. Report 50:prescribing, recording, and reporting photon beam therapy[J]. Med Phys, 1994, 21(6):833-834. DOI:10.1118/1.597396.
[14] International Commission on Radiation Units and Measurements. Report 62:Prescribing, recording and reporting photon beam therapy (supplement to ICRU report 50)[J]. Med Phys, 1994, 21(6):834. DOI:10.1118/1.597396.
[15] 赵充, 卢泰祥, 韩非, 等. 139例鼻咽癌调强放疗的临床研究[J]. 中华放射肿瘤学杂志, 2006,15(1):1-6. DOI:10.3760/j.issn:1004-4221.2006.01.001.
Zhao C, Lu TX, Han F, et al. Clinical study of 139 nasopharyngeal carcinoma patients for intensity modulated radiation therapy[J]. Chin J Radiat Oncol, 2006, 15(1):1-6. DOI:10.3760/j.issn:1004-4221.2006.01.001.
[16] Du CR, Ying HM, Kong FF, et al. Concurrent chemoradiotherapy was associated with a higher severe late toxicity rate in nasopharyngeal carcinoma patients compared with radiotherapy alone:a meta-analysis based on randomized controlled trials[J]. Radiat Oncol, 2015, 10(1):70. DOI:10.1186/s13014-015-0377-9.
[17] Chen YP, Tang LL, Yang Q, et al. Induction chemotherapy plus concurrent chemoradiotherapy in endemic nasopharyngeal carcinoma:individual patient data pooled analysis of four randomized trials[J]. Clin Cancer Res, 2018, 24(8):1824-1833. DOI:10.1158/1078-0432. CCR-17-2656.