局部复发鼻咽癌调强放疗与常规放疗的疗效比较

目的 比较调强放疗(IMRT)与二维常规放疗(2DCRT)治疗局部复发鼻咽癌的疗效及不良反应发生率。方法 292例局部复发鼻咽癌患者中,81例2DCRT,211例IMRT。采用UICC 2009年分期标准进行复发再分期。Kaplan-Meier法计算生存率并Logrank法检验,Cox法多因素预后分析。结果 随访率为91.8%,随访时间满 3年者2DCR、IMRT者分别为38、106例。2DCRT、IMRT者 3年总生存率不同(36.9%、51.3%,χ²=8.44,P=0.004),无局部进展生存率也不同(63.3%、86.0%,χ²=13.83,P=0.000),无远处转移生存率相似(79.0%、83.5%,χ²=0.25,P=0.618)。多因素分析结果显示T分期、IMRT是影响总生存和无局部进展生存的因素(χ²=9.51、5.20,P=0.002、0.023和 χ²=4.84、9.24,P=0.027、0.002)。2DCRT组3+4级张口困难和放射性脑病发生率高于IMRT组的(43.2%和24.7%∶19.9%和8.1%,χ²=16.37,P=0.000和 χ²=14.64,P=0.000),而IMRT鼻咽黏膜坏死和(或)鼻咽大出血的发生率高于2DCRT的(33.2%∶7.4%,χ²=20.19,P=0.000)。结论 IMRT可提高局部复发鼻咽癌患者的无局部进展生存率和总生存率,IMRT还可降低局部复发鼻咽癌患者再程放疗严重张口困难和放射性脑病发生率,但增加鼻咽黏膜溃疡和(或)鼻咽大出血发生率。

Comparison of effectiveness of intensity-modulated radiotherapy with conventional two-dimensional radiotherapy for patients with locally recurrent nasopharyngeal carcinoma

Objective To compare the efficacy and side-effects in locally recurrent nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) and two-dimensional conventional radiotherapy (2DCRT). Methods Among the 292 newly diagnosed, nonmetastatic recurrent NPC, 211 were treated with IMRT and 81 with 2DCRT. All patients were staged according to the seventh edition of the UICC 2009 staging system. Kaplan-Meier and Logrank methods were used for survival analysis. A Cox proportional hazard model was used to examine prognostic factors. Results The follow-up rate was 91.8%, there are 38 patients in 2DCRT and 106 patients in IMRT group was followed more than 3 years. There were significant differences in the 3-year actuarial overall survival (OS) rate (36.9% and 51.3%,χ²=8.44,P=0.004) and local progression-free survival (LRFS) rate (63.3% and 86.0%,χ²=13.83,P=0.000), and no significant differences in actuarial distant metastasis free survival rates (79.0% and 83.5%,χ²=0.25,P=0.618) between the 2DCRT group and the IMRT group. Multivariate analysis showed that T category and IMRT (yes vs. no) were the independently prognostic factors for OS and LRFS (χ²=9.51, 5.20, P=0.002, 0.023 and χ²=4.84, 9.24, P=0.027, 0.002). The incidence of grade 3and4 trismus and radiation-induced encephalopathy were 19.9%, 8.1% for the IMRT group and 43.2%, 24.7% for the 2DCRT group (χ²=16.37,P=0.000 and χ²=14.64,P=0.000). Whereas, severe mucosa necrosis and/or massive hemorrhage in the nasopharynx was observed in IMRT group which was not common in 2DCRT (33.2%∶7.4%,χ²=20.19,P=0.000). Conclusions Higher local tumor control and overall survival were achieved by IMRT than 2DCRT, the incidence of severe trismus and radiation-induced encephalopathy was also reduced by IMRT, in cost of a higher incidence of mucosa necrosis and/or massive hemorrhage in the nasopharynx.