MAJOR LATE TOXICITIES AFTER CONFORMAL RADIOTHERAPY FOR NASOPHARYNGEAL CARCINOMA-PATIENT- AND TREATMENT-RELATED RISK FACTORS
MAJOR LATE TOXICITIES AFTER CONFORMAL RADIOTHERAPY FOR NASOPHARYNGEAL CARCINOMA-PATIENT- AND TREATMENT-RELATED RISK FACTORS
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DOI：
10.1016/j.ijrobp.2008.05.023
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发表时间：
2009-03-15
影响因子：
7
通讯作者：
Bentzen, Soren M.
中科院分区：
文献类型：
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作者：
Lee, Anne W. M.;Ng, W. T.;Bentzen, Soren M.
目的：回顾性分析鼻咽癌晚期毒性的影响因素。方法和材料：1998年至2003年间，422例患者接受了适形技术治疗，每日剂量为2 Gy，总剂量为70 Gy。232例患者采用常规分馏（每周5次），190例患者采用加速分馏（每周6次）。171例患者单独接受基础放疗（第一组），55例患者分两次接受5 Gy的额外放疗（第二组），196例患者同时接受顺铂化疗（第三组）。结果：3组5年总毒副率明显高于1组（37% vs. 27%, p 0.009）。虽然2组的总发生率没有升高（28% vs. 27%, p = 0.697），但颞叶坏死发生率明显升高（4.8% vs. 0%,p = 0.015）。多因素分析显示，年龄和同期化疗是显著因素。化疗总毒性的风险比为1.99（95%可信区间为1.32-2.99,p = 0.001）。耳蜗平均辐射剂量是影响耳聋的另一个显著因素，每增加1 gy，风险比为1.03（95%可信区间，1.01-1.05,p = 0.005）。接受bbb50 Gy的耳蜗的失聪率显著高于对照组（1组为18% vs. 7%； 3组为22% vs. 14%）。结论：鼻咽癌的治疗范围极窄，剂量增加可导致脑坏死明显增加。影响耳蜗死亡风险的重要因素包括年龄、同步放化疗和对耳蜗较大的辐射剂量。(C) 2009爱思唯尔公司
Purpose: To retrospectively analyze the factors affecting late toxicity for nasopharyngeal carcinoma.Methods and Materials: Between 1998 and 2003, 422 patients were treated with a conformal technique with 2-Gy daily-fractions to a total dose of 70 Gy. Conventional fractionation (5 fractions weekly) was used in 232 patients and accelerated fractionation (6 fractions weekly) in 190 patients. One hundred seventy-one patients were treated with the basic radiotherapy course alone (Group 1), 55 patients had an additional boost of 5 Gy in 2 fractions (Group 2), and 196 patients underwent concurrent cisplatin-based chemotherapy (Group 3).Results: The 5-year overall toxicity rate was significantly greater in Group 3 than in Group 1 (37% vs. 27%, p 0.009). Although the overall rate in Group 2 was not elevated (28% vs. 27%, p = 0.697), a significant increase in temporal lobe necrosis was observed (4.8% vs. 0%,p = 0.015). Multivariate analyses showed that age and concurrent chemotherapy were significant factors. The hazard ratio of overall toxicity attributed to chemotherapy was 1.99 (95% confidence interval, 1.32-2.99,p = 0.001). The mean radiation dose to the cochlea was another significant factor affecting deafness, with a hazard ratio of 1.03 (95 % confidence interval, 1.01-1.05, p = 0.005) per 1-Gy increase. The cochlea that received >50 Gy had a significantly greater deaf rate (Group 1, 18% vs. 7%; and Group 3, 22% vs. 14%).Conclusion: The therapeutic margin for nasopharyngeal carcinoma is extremely narrow, and a significant increase in brain necrosis could result from dose escalation. The significant factors affecting the risk of dearness included age, concurrent chemoradiotherapy, and greater radiation dose to the cochlea. (C) 2009 Elsevier Inc.