Prognostic factors affecting the outcome of nasopharyngeal carcinoma
Prognostic factors affecting the outcome of nasopharyngeal carcinoma
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DOI：
10.1093/jjco/hyg092
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发表时间：
2003-10-01
影响因子：
2.4
通讯作者：
Wang, AY
中科院分区：
文献类型：
--
作者：
Liu, MT;Hsieh, CY;Wang, AY
背景资料：本研究的目的是评估鼻咽癌患者接受多节段调强放疗联合或不联合化疗的疗效，并分析患者、肿瘤和治疗特点，确定结果。自1999年6月至2003年4月，我们共收治鼻咽癌患者83例，男70例，女13例，年龄介乎25至85岁（中位数48岁）。T1肿瘤19例，T2肿瘤35例，T3肿瘤6例，T4肿瘤23例。64例患者有颈部淋巴结转移。20例患者单独接受放射治疗，63例患者同时接受放化疗。原发肿瘤的累积放射剂量范围为70.2至77.4戈伊（中位数，75.6戈伊）。随访3 ~ 41.53个月（中位17个月）。结果：81例（97.5%）局部完全缓解。局部衰竭2例，淋巴结衰竭1例，全身衰竭14例。总生存率、无病生存率和疾病特异性生存率在1年时分别为83%、84%和93%，在2年时分别为82%、74%和88%，在3年时分别为82%、61%和88%。在单因素分析中，疾病的T分期是无病生存率的重要预测因素，有利于早期（T1 + T2）疾病（P = 0.040）。原发性肿瘤的累积放射剂量是疾病特异性生存率的重要预测因子，对>75.6戈伊的患者有利（P = 0.010）。疾病分期（P= 0.007）、N-分级（P= 0.046）和原发肿瘤累积剂量（P = 0.046）是影响总生存率的重要预后因素。结论：多节段调强放疗可提高鼻咽癌的局部控制率。远处转移仍然是影响生存的主要因素。需要更有效的化疗方案和其他全身性药物来降低远处转移率。
Background: The aim of the study is to evaluate patients with nasopharyngeal carcinoma treated with multisegmental intensity-modulated radiotherapy with or without chemotherapy and analyze patient, tumor and treatment characteristics, determining outcome.Methods: From June 1999 through to April 2003, we treated in our institution 83 patients with nasopharyngeal carcinoma, 70 males and 13 females, their ages ranging from 25 to 85 years (median, 48 years). Nineteen patients had T1 tumors, 35 had T2 tumors, six had T3 tumors and 23 had T4 tumors. Sixty-four patients had cervical lymph node metastasis. Twenty patients were treated with radiation therapy alone and 63 patients with concurrent chemoradiotherapy. Cumulative radiation dose to primary tumor ranged from 70.2 to 77.4 Gy (median, 75.6 Gy). Follow-up ranged from 3 to 41.53 months (median, 17 months).Results: Local complete response was achieved in 81 patients (97.5%). Local failure was observed in two patients, nodal failure in one patient and systemic failure in 14 patients. Overall survival, disease-free survival and disease-specific survival were 83, 84 and 93%, respectively, at 1 year, 82, 74 and 88%, respectively, at 2 years and 82, 61 and 88%, respectively, at 3 years. In univariate analysis, T stage of disease was a significant predictor of disease-free survival favoring those with early-stage (T1 + T2) disease (P = 0.040). Cumulative radiation dose to primary tumor was a significant predictor of disease-specific survival favoring those with >75.6 Gy (P = 0.010). Stage of disease (P= 0.007), N-classification (P= 0.046) and cumulative dose to primary tumor (P = 0.046) were significant prognostic factors for overall survival.Conclusions: High locoregional control for nasopharyngeal carcinoma was achieved with multisegmental intensity-modulated radiotherapy. Distant metastases are still the main impact on survival. More effective chemotherapy regimens and other systemic agents are needed to decrease the rate of distant metastasis.