Taxane-based Induction Chemotherapy Plus Concurrent Chemoradiotherapy in Nasopharyngeal Carcinoma: Prospective Results from a Non-endemic Cohort
Taxane-based Induction Chemotherapy Plus Concurrent Chemoradiotherapy in Nasopharyngeal Carcinoma: Prospective Results from a Non-endemic Cohort
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DOI：
10.1016/j.clon.2019.06.011
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发表时间：
2019-12-01
影响因子：
3.4
通讯作者：
D'Cruz, A.
中科院分区：
文献类型：
--
作者：
Ghosh-Laskar, S.;Pilar, A.;D'Cruz, A.
目的：报道来自非流行地区的大队列局部区域晚期鼻咽癌（LA-NPC）的诱导化疗（ICT）后放化疗（CTRT）的结果。材料和方法：2008年1月至2015年7月，我院201例经组织学证实的非转移性鼻咽癌患者行ICT + CTRT治疗。所有患者都接受了2 - 3个周期的紫杉烷ICT治疗方案。所有患者均采用调强放疗（IMRT）技术进行放疗。结果：中位随访37个月（范围7-110个月）后，整个队列的3年无病生存期（DFS）、局部无复发生存期（LRFS）、远处无转移生存期（DMFS）和总生存期分别为72.85、83.83和87.4%。在多变量分析中，组织学是DFS、LRFS和总生存率的独立预测因子，角质化鳞状细胞癌的组织学预测结果更差。淋巴结分期是DFS、DMFS和总生存期的独立预测因子。年龄、性别、种族、肿瘤分期和对ICT的反应对任何结果都没有显著影响。在最后一次随访中，19%的患者出现2级或更严重的皮下纤维化，24%的患者出现2级或更严重的口干。在最后的随访中，39%的患者出现了临床甲状腺功能减退。结论：在IMRT时代，ICT联合CTRT可为LA-NPC患者提供良好的局部控制、远程控制和总生存率。然而，远距离的失败仍然是一个问题，可能需要进一步的系统强化。(C) 2019皇家放射科医师学院。Elsevier Ltd.出版。版权所有。
Aims: To report the outcomes of induction chemotherapy (ICT) followed by chemoradiotherapy (CTRT) for a large cohort of locoregionally advanced nasopharyngeal cancer (LA-NPC) from a non-endemic region.Materials and methods: Between January 2008 and July 2015, 201 patients with histologically proven, non-metastatic NPC were treated with ICT followed by CTRT at our institute. All the patients received two to three cycles of a taxane-based ICT regimen. Radiotherapy was delivered using an intensity-modulated radiotherapy (IMRT) technique in all patients.Results: After a median follow-up of 37 months (range: 7-110 months), the 3-year disease-free survival (DFS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS) and overall survival of the entire cohort was 72, 85, 83 and 87.4%, respectively. On multivariate analysis, histology was an independent predictor of DFS, LRFS and overall survival, with keratinising squamous cell carcinoma histologies predicting a worse outcome. The nodal stage was an independent predictor of DFS, DMFS and overall survival. Age, gender, ethnicity, tumour stage and response to ICT did not significantly affect any of the outcomes. Grade 2 or worse subcutaneous fibrosis was seen in 19% of patients at last follow-up and grade 2 or worse xerostomia was seen in 24% of patients. Thirty-nine per cent of patients developed clinical hypothyroidism at last follow-up.Conclusion: ICT followed by concurrent CTRT in the IMRT era provides excellent locoregional control, distant control and overall survival rates in patients with LA-NPC. However, distant failure continues to be a problem and may require further systemic intensification. (C) 2019 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.