Local control in advanced cancer of the nasopharynx: Is a boost dose by endocavitary brachytherapy of prognostic significance?
Local control in advanced cancer of the nasopharynx: Is a boost dose by endocavitary brachytherapy of prognostic significance?
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DOI：
10.1016/j.brachy.2012.06.001
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发表时间：
2013-01-01
期刊：
影响因子：
1.9
通讯作者：
Teguh, David N.
中科院分区：
文献类型：
--
作者：
Levendag, Peter C.;Keskin-Cambay, Fatma;Teguh, David N.
目得：目的：探讨腔内近距离放射治疗（endocavitary brachytherapy，EBT）能否提高原发剂量，改善局部肿瘤控制效果。方法：收集“维也纳”、“鹿特丹”和“阿姆斯特丹”3个鼻咽癌病例资料，共411例。鹿特丹系列包括72例患者（3,4例T1，2 N+和38例T3，4 N 0，+），接受新辅助化疗，随后接受外照射放疗（剂量70/2戈伊）。在70/2戈伊后，通过EBT（在T1的情况下，2N+）或立体定向放射（在T3的情况下，4个肿瘤）施加加强。阿姆斯特丹（Antoni货车Leeuwenhoek医院/荷兰癌症研究所）系列包括76例患者（40例T1，2N+和36例T3，4 N 0，+），接受剂量为70/2戈伊的放疗和伴随化疗。结果：在T1，2N+肿瘤的情况下，如果应用加强，局部复发率（LRR）显著较小，即0%（0/34，EBT加强）vs. 14%（14/102，无EBT加强）（p = 0.023）。对于T3，4个肿瘤，LRR为10%（4/38，EBT或立体定向放射增强）vs. 15%（17/111，无增强）（p = 0.463）。对于高级NPC（T1，2N+ vs. T3，4 N+，0），对于早期T分期（T1，2N+），EBT增强似乎是向鼻咽输送高度适形高剂量辐射的极好方式，局部控制率高。对于晚期T分期（T3，4 N+，0），LRR降低（10% vs. 15%）不显著（p = 0.463）。(C)2013年美国近距离放射治疗协会。爱思唯尔公司出版All rights reserved.
PURPOSE: To analyze whether local tumor control in advanced nasopharyngeal cancer (NPC) can be optimized by boosting the primary dose by endocavitary brachytherapy (EBT).METHODS AND MATERIALS: To study the role of EBT, three data sets on NPC, that is, the "Vienna", "Rotterdam," and "Amsterdam" series, with a total number of 411 advanced NPC patients, were available. The Rotterdam series consisted of 72 patients (34 T1,2N+ and 38 T3,4N0,+) and were treated with neoadjuvant chemotherapy followed by external beam radiotherapy (dose 70/2 Gy). After 70/2 Gy, a boost was applied by EBT (in case of T1,2N+) or stereotactic radiation (in case of T3,4 tumors). The Amsterdam (Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute) series consisted of 76 patients (40 T1,2N+ and 36 T3,4N0,+) and were irradiated to a dose of 70/2 Gy with concomitant chemotherapy. No second boost by EBT was applied.RESULTS: In the case of T1,2N+ tumors, the local relapse rate (LRR) was significantly smaller if a boost was applied, that is, 0% (0/34, EBT boost) vs. 14% (14/102, no EBT boost) (p = 0.023). For the T3,4 tumors, an LRR of 10% (4/38, EBT or stereotactic radiation boost) vs. 15% (17/111, no boost) was found (p = 0.463).CONCLUSIONS: In the case of advanced NPC (T1,2N+ vs. T3,4N+,0), for early T-stages (T1,2N+), an EBT boost seems an excellent way to deliver highly conformal high doses of radiation to the nasopharynx, with high local control rates. For advanced T-stages (T3,4N+,0), the reduction in LRR (10% vs. 15%) was not significant (p = 0.463). (C) 2013 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.