Failure patterns and survival in patients with nasopharyngeal carcinoma treated with intensity modulated radiation in Northwest China: a pilot study.
Failure patterns and survival in patients with nasopharyngeal carcinoma treated with intensity modulated radiation in Northwest China: a pilot study.
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DOI：
10.1186/1748-717x-7-2
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发表时间：
2012-01-10
期刊：
影响因子：
--
通讯作者：
Long X
中科院分区：
文献类型：
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作者：
Wang J;Shi M;Hsia Y;Luo S;Zhao L;Xu M;Xiao F;Fu X;Li J;Zhou B;Long X
目的：探讨中国西北地区鼻咽癌调强放疗（IMRT）患者的临床疗效和治疗失败模式。2006年1月至2009年12月，西京医院收治了138例鼻咽癌患者。其中，25例I-II期患者仅接受了IMRT治疗，113例III-IVb期患者接受了IMRT治疗并完成了铂类化疗。IMRT处方剂量为鼻咽部病变部位68 ~ 74 Gy，阳性淋巴结30~33组为66 ~ 72 Gy，高危区和低危区30~33、28组PTV分别为60 ~ 63 Gy、50.4~56 Gy。治疗前测定血浆eb病毒（EBV） DNA载量。观察临床毒副作用、结果和失败模式。中位随访时间为23个月（2 ~ 53个月）。EBV感染阳性率仅为15.9%。36例患者出现整体疾病衰竭，其中99%属于III/IV期疾病。其中远处转移26例，局部复发6例，局部复发4例。3年局部控制率（LCR）、远处无转移生存率（MFS）、无病生存率（DFS）和总生存率（OS）分别为93.9%、79.5%、70%和83.1%。多因素分析显示，放疗前年龄和贫血是OS的独立预测因素。IMRT联合或不联合化疗可提高西北地区鼻咽癌患者的长期生存率。远处转移成为治疗失败的主要原因。年龄和放疗前贫血是鼻咽癌患者预后的主要因素。
To evaluate the clinical outcomes and patterns of failure in patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiotherapy (IMRT) in Northwest China. From January 2006 to December 2009, 138 NPC patients were treated at Xijing Hospital. Of them, 25 cases with stage I-II received IMRT only, 113 cases with stage III-IVb received IMRT plus accomplished platinum-based chemotherapy. The IMRT prescribed dose was PTV 68-74 Gy to gross disease in nasopharynx and 66-72 Gy to positive lymph nodes in 30-33 fractions, and high risk and low risk region PTV was 60-63 Gy and 50.4~56 Gy in 30~33 and 28 fractions respectively. Plasma Epstein Barr virus (EBV) DNA load was measured before treatment. The clinical toxicities, outcomes and patterns of failure were observed. The median follow up time was 23 months (range 2 to 53 months). EBV infection positive was only 15.9%. Overall disease failure developed in 36 patients, 99% belonged to stage III/IV disease. Among these, there were 26 distant metastases, 6 local recurrence, and 4 regional recurrence. The 3-year local control rate(LCR), distant metastasis-free survival (MFS), disease-free survival (DFS) and the overall survival (OS) was 93.9%, 79.5%, 70% and 83.1% respectively. Multivariate analyses revealed that age and anemia pre-radiotherapy were independent predictors for OS. IMRT with or without chemotherapy can improve the long term survival of NPC patients in Northwest China. Distant metastasis becomes the main cause of treatment failure. Age and anemia before radiotherapy were the main prognosis factors of NPC patients.