鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

同期放化疗对比单纯放疗治疗非高发区T1~2N1M0期鼻咽癌远期疗效观察

目的:回顾性配对分析以适形调强放疗为基础的不同治疗模式对非高发区T1~2N1M0期鼻咽癌患者预后的影响。方法:回顾性分析2010年1月至2015年12月河南省肿瘤医院初治的行根治性放疗的T1~2N1M0期鼻咽癌患者,筛选出51对患者(单纯放疗组和同期放化疗组各51例)进行配对分析。比较两组患者各项生存率及急性不良反应。结果:全组5年总生存率、无局部复发生存率、无区域复发生存率、无远处转移生存率分别为94.1%、93.6%、96.7%、90.9%。单纯放疗组与同期放化疗组相比,5年总生存率(95.9%vs. 92.2%,P=0.894)、无局部复发生存率(94.1%vs. 93.3%,P=0.976)、无区域复发生存率(95.8%vs. 97.6%,P=0.572)、无远处转移生存率(91.4%vs. 90.2%,P=0.716),差异均无统计学意义。急性不良反应方面,与单纯放疗组相比,同期放化疗组呕吐、中性粒细胞减少、白细胞减少、血红蛋白减少和黏膜炎的发生率显著升高。结论:对于T1~2N1M0期鼻咽癌患者,同期化疗的加入并未明显改善患者预后,且急性不良反应增加。     

基于IMRT的Ⅱ期鼻咽癌同期放化疗与单纯放疗远期疗效比较

目的 评价以IMRT为基础的不同治疗模式对Ⅱ期鼻咽癌患者预后的影响。方法 回顾分析123例Ⅱ期鼻咽癌患者的临床资料,其中单纯放疗81例,同期放化疗42例。Kaplan-Meier计算生存率并Logrank检验。结果 全组5年OS、LRFS、DMFS、PFS分别为96.7%、94.7%、93.1%、87.8%。单纯放疗组与同期放化疗组相比,5年OS (98.7%:92.9%,P=0.569)、LRFS (94.8%:94.5%,P=0.770)、DMFS (94.5%:90.2%,P=0.408)、PFS (90.6%:82.2%,P=0.340)均无明显差异。T₂N₁期患者两组5年各项生存率仍无明显差异(P=0.929、0.967、0.917、0.492)。急性不良反应方面同期放化疗组中性粒细胞减少、白细胞减少、血红蛋白减少和放射性黏膜反应发生率明显升高(P=0.000、0.000、0.012、0.010),而两组晚期不良反应发生率相近(P=0.823、0.622、0.113)。结论 对Ⅱ期患者同期化疗的加入并未改善患者预后,但急性不良反应明显增加。     

133例Ⅲ期鼻咽癌调强放疗的疗效及不良反应分析

背景与目的:调强放疗(intensity-modulated radiation therapy,IMRT)是最大限度提高肿瘤靶区照射剂量的同时明显减少周围正常组织的剂量的放疗技术,调强放疗联合化疗治疗局部晚期鼻咽癌取得了较好的疗效,如何在此基础上进一步提高疗效成为肿瘤学者共同关注的话题.鼻咽癌分期不同,疗效不同,同一分期各亚组间疗效有无差别,尚有待研究.通过回顾性分析临床Ⅲ期鼻咽癌各亚组间调强放疗联合化疗的疗效,探讨进一步提高疗效的方法.方法:对我院2003年1月-2006年6月期间收治的133例临床Ⅲ期鼻咽癌患者进行分析,根据AJCC 2002分期,其中T3N0 7例(5.3％),T3N1 39例(29.3％),T2N2 48例(36.1％),T3N2 39例(29.3％).所有患者均完成调强放疗,124例患者行诱导化疗,其中24例患者行同期化疗,33例患者行辅助化疗.结果:全组5年局部控制率、无远处转移生存率、无瘤生存率和总生存率分别为:90.9％、89.9％、82.5％和83.4％.T2、T3期患者5年局部控制率分别为93.1％、89.4％(x2=0.407,P=0.524),无远处转移生存率分别为91.2％、89.3％(x2=0.152,P=0.697),无瘤生存率分别为86.5％、80.0％(x2=0.899,P=0.343),总生存率分别为81.1％、84.7％(x2=0.311,P=0.577).N0-1、N2期患者5年局部控制率分别为91.1％、90.9％(x2=0.007,P=0.933),无远处转移生存率分别为97.8％、85.8％ (x2=4.69,P=0.030),无瘤生存率分别为88.9％、79.2％(x2=1.746,P=0.183 6),总生存率分别为93.5％、78.1％(x2=5.052,P=0.025).辅助化疗对IMRT Ⅲ期鼻咽癌未能获益,但3、4级毒性不良反应明显增加(48％ vs 27.6％,P＜0.005).结论:对临床Ⅲ期鼻咽癌患者,IMRT联合化疗可以取得较好的疗效,N0-1期较N2期患者有较高的总生存率和无远处转移生存率,进一步提高IMRT Ⅲ期鼻咽癌疗效还需寻找更有效的化疗药物、靶向药物及更合理的联合治疗方案.     

鼻咽癌调强放疗后长期生存结果及失败模式分析

目的 回顾分析IMRT治疗鼻咽癌的10年生存结果及失败模式,为鼻咽癌的优化治疗提供参考。方法 收集2001-2008年间865例采用IMRT的鼻咽癌患者的临床资料。生存分析采用Kaplan-Meier法,Logrank检验和单因素分析,Cox模型多因素预后分析。结果 中位随访时间为132.0个月,全组患者10年无局部复发生存(LRFS)、无远处转移生存(DMFS)、无进展生存(PFS)、肿瘤特异生存(DSS)分别为92.0%、83.4%、75.7%、78.6%。共210例死亡,其中124例(124/210,59.0%)死于远处转移, 47例(41/210,22.3%)死于局部区域复发。DSS的独立不良预后因素包括年龄>50岁(P=0.00)、LDH≥245 IU/L (P=0.00)、Hb<120 g/L (P=0.01)、T2-T4期(P=0.00)、N1-N3期(P=0.00)和GTV-nx>20 cm³(P=0.00)。Ⅱ期鼻咽癌患者单纯放疗组与联合化疗组10年LRFS、DMFS、DSS均相近(P=0.83、0.22、0.23),Ⅲ期鼻咽癌患者联合化疗组10年LRFS、DSS均优于单纯放疗组(P=0.01、0.01)但10年DMFS相近(P=0.14),Ⅳ a+Ⅳ b期患者总体预后较差。结论 IMRT改善了鼻咽癌患者的远期生存,远处转移成为最主要的失败模式;而Ⅰ-Ⅱ期患者采用单纯IMRT可取得满意生存结果,联合化疗可进一步提高Ⅲ期患者LRFS及DSS,而Ⅳ a+Ⅳ b期患者治疗模式仍需更多探讨。     

Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy

Although many studies have investigated intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), sample sizes in the reported studies are usually small and different in outcomes in different T and N subgroups are seldom analyzed. Herein, we evaluated the outcomes of NPC patients treated with IMRT and further explored treatment strategy to improve such outcome. We collected clinical data of 865 NPC patients treated with IMRT alone or in combination with chemotherapy, and classified all cases into the following prognostic categories according to different TNM stages: early stage group (T1-2N0-1M0), advanced local disease group (T3-4N0-1M0), advanced nodal disease group (T1-2N2-3M0), and advanced locoregional disease group (T3-4N2-3M0). The 5-year overall survival (OS), local relapse-free survival (LRFS), and distant metastases-free survival (DMFS) were 83.0%, 90.4%, and 84.0%, respectively. The early disease group had the lowest treatment failure rate, with a 5-year OS of 95.6%. The advanced local disease group and advanced nodal disease group had similar failure pattern and treatment outcomes as well as similar hazard ratios for death (4.230 and 4.625, respectively). The advanced locoregional disease group had the highest incidence of relapse and death, with a 5-year DMFS and OS of 62.3% and 62.2%, respectively, and a hazard ratio for death of 10.402. Comparing with IMRT alone, IMRT in combination with chemotherapy provided no significant benefit to locoregionally advanced NPC. Our results suggest that the decision of treatment strategy for NPC patients should consider combinations of T and N stages, and that IMRT alone for early stage NPC patients can produce satisfactory results. However, for advanced local, nodal, and locoregional disease groups, a combination of chemotherapy and radiotherapy is recommended.     

Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: An analysis of survival and treatment toxicities

Background and purpose

To evaluate the long-term survival outcomes and toxicity of NPC patients treated with intensity-modulated radiotherapy (IMRT).

Materials and methods

From May 2001 to October 2008, 868 non-metastatic NPC patients treated by IMRT were analyzed retrospectively. The Radiation Therapy Oncology Group (RTOG) criteria were used to assess toxicity.

Results

With a median follow-up of 50 months (range, 5–115 months), the 5-year estimated disease specific survival (DSS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) were 84.7%, 91.8%, 96.4% and 84.6%, respectively. Of the 868 patients, 186 (21.3%) developed failure after treatment. Distant metastasis was the major failure pattern after treatment. The 5-year OS rate in patients with stage I, II, III, and IVa–b were 100.0%, 94.3%, 83.6%, and 70.5%, respectively. The 5-year LRFS rate in patients with stage T1, T2, T3, and T4 disease were 100.0%, 96.0%, 90.4%, and 83.3%, respectively (χ² = 26.32, P < 0.001). The 5-year DMFS for N0, N1, N2, and N3 patients were 96.1%, 85.6%, 73.7%, and 62.1%, respectively (χ² = 65.54, P < 0.001). Concurrent chemotherapy failed to improve survival rates for patients with advanced locoregional disease. The most common acute toxicities were mainly in grade 1 or 2. Compared with IMRT alone, IMRT plus concurrent chemotherapy increased the severity of acute toxicities. The incidence of brain radiation damage was relatively high (5.5%, 48/868 cases), and was not observed in patients with stage T1–2.

Conclusion

IMRT for NPC yielded excellent survival outcomes, and distant metastasis was the most commonly seen failure pattern after treatment. The role of concurrent chemotherapy for advanced locoregional stage NPC patients needs to be further investigated. Treatment-related toxicities were well tolerable. However, the incidence of brain radiation damage was relatively high, especially for patients with advanced T-stage.     

Treatment outcomes and late toxicities of 869 patients with nasopharyngeal carcinoma treated with definitive intensity modulated radiation therapy: new insight into the value of total dose of cisplatin and radiation boost

This study was to report the long-term outcomes and toxicities of nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). From 2009 to 2010, 869 non-metastatic NPC patients treated with IMRT were retrospectively enrolled. With a median follow-up of 54.3 months, the 5-year estimated local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were 89.7%, 94.5%, 85.6%, 76.3%, 84.0%, respectively. In locally advanced NPC, gender, T, N, total dose of cisplatin more than 300 mg/m² and radiation boost were independent prognostic factors for DMFS and DFS. Age, T, N and total dose of cisplatin were independent prognostic factors for OS. Radiation boost was an adverse factor for LRFS, RRFS, DMFS and DFS. Concurrent chemotherapy was not an independent prognostic factor for survival, despite marginally significant for DMFS in univariate analysis. Concurrent chemotherapy increased xerostomia and trismus, while higher total dose of cisplatin increased xerostomia and otologic toxicities. In conclusion, IMRT provided satisfactory long-term outcome for NPC, with acceptable late toxicities. Total dose of cisplatin was a prognostic factor for distant metastasis and overall survival. The role of concurrent chemotherapy and radiation boost in the setting of IMRT warrants further investigation.     

鼻咽癌调强放疗疗效及预后影响因素分析(附691例)

目的:回顾性分析我院采用调强放疗(intensity-modulated radiotherapy,IMRT)治疗鼻咽癌的疗效及预后影响因素.方法:收集2009年01月至2015年08月691例鼻咽癌患者的临床资料进行生存分析.结果:中位随访时间为62.8个月,全组患者5年总生存(overall survival,OS...     

The role of concurrent chemotherapy in intensity-modulated radiotherapy for patients with stage Ⅲ nasopharyngeal carcinoma

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.     

IMRT同期化疗在Ⅲ期鼻咽癌中作用分析

目的 探讨IMRT同期化疗对Ⅲ期鼻咽癌患者预后的影响和作用。方法 回顾性分析2001-2008年间中山大学肿瘤防治中心接受单纯IMRT和IMRT同期铂类药物化疗的 251例Ⅲ期鼻咽癌患者,分析相关预后因子和探讨IMRT同期化疗作用。采用Kaplan-Meier法计算生存率,组间差异比较采用log-rank检验,Cox模型预后因素分析。结果 全组 10年无局部区域复发生存(LRFS)、无远处转移生存(DMFS)、无进展生存(PFS)和总生存(OS)率分别为88.6%、81.1%、68.8%和75.1%。单因素和多因素分析显示N分期和鼻咽肿瘤体积是最重要的预后影响因素,同期化疗有助于改善患者PFS和OS (均 P<0.05)。T3N0-1期患者单纯放疗组和同期放化疗组各生存指标均相近(10年LRFS为93.8%∶93.2%,P=0.933;10年DMFS为80.9%∶86.8%,P=0.385;10年PFS为70.6%∶77.7%,P=0.513;10年OS为71.8%∶83.6%,P=0.207);T1-3N2期患者同期放化疗的LRFS、PFS和OS优于单纯放疗(10年LRFS为87.3%∶66.7%,P=0.016;10年PFS为70.2%∶41.0%,P=0.003;10年OS为78.5%∶51.7%,P=0.008),DMFS有提高趋势(10年DMFS为80.3%∶66.4%,P=0.103)。结论 IMRT中同期化疗的加入有助于改善Ⅲ期鼻咽癌患者预后,在N2期组获益较为明显,需要根据患者治疗失败风险予以个体化治疗方案。