WHOLE-FIELD SIMULTANEOUS INTEGRATED-BOOST INTENSITY-MODULATED RADIOTHERAPY FOR PATIENTS WITH NASOPHARYNGEAL CARCINOMA
WHOLE-FIELD SIMULTANEOUS INTEGRATED-BOOST INTENSITY-MODULATED RADIOTHERAPY FOR PATIENTS WITH NASOPHARYNGEAL CARCINOMA
复制标题
DOI：
10.1016/j.ijrobp.2009.01.084
复制
发表时间：
2010-01-01
影响因子：
7
通讯作者：
Tung, Stewart Y.
中科院分区：
文献类型：
--
作者：
Wong, Frank C. S.;Ng, Alice W. Y.;Tung, Stewart Y.
目的：回顾性分析我们的新诊断的非播散性鼻咽癌患者的治疗结果与调强放疗使用全场同步集成boost technique.Methods和材料：共175例患者治疗与WF-SIB之间的中期2004年和2005年有资格纳入研究。疾病分期分布为IA期10.9%，IIA期2.3%，IIB期21.7%，III期41.1%，IVA期14.9%，IVB期9.1%。在175例患者中，分别有2例（1.2%）、10例（5.7%）和163例（93.1%）具有世界卫生组织I、II和III型组织学特征。我们规定在6.5周内在三个计划靶体积（PTV;分别为PTV 70、PTV 60和PTV 54）的周围分33次给予70戈伊、60戈伊和54戈伊。在175例患者中，46例早期T期疾病接受了近距离放射治疗，127例晚期局部或区域疾病接受了化疗。总的3年局部无失败生存率、区域无失败生存率、远处无失败生存率和总生存率分别为93.6%、93.3%、86.6%和87.2%。考克斯回归分析显示，N2-N3期疾病（p = 0.029）和PTV（p = 0.024）分别是预测远处转移失败和总生存率差的独立因素。23.4%的患者发生3级急性粘膜炎/咽炎，T4期疾病是粘膜炎/咽炎的唯一显著预测因素（p = 0.021）。结论：在本研究中，剂量>70戈伊的全视野同步综合增强调强放疗实现了出色的局部控制，而没有过度发生严重的急性粘膜炎/咽炎。对于具有大肿瘤和晚期N期疾病的患者使用这种高度适形治疗的策略是未来研究的潜在调查领域。(C)2010年爱思唯尔公司
Purpose: To retrospectively review the outcomes of our patients with newly diagnosed nondisseminated nasopharyngeal carcinoma treated with intensity-modulated radiotherapy using a whole-field simultaneous integrated-boost technique.Methods and Materials: A total of 175 patients treated with WF-SIB between mid-2004 and 2005 were eligible for study inclusion. The distribution of disease by stage was Stage IA in 10.9%, Stage IIA in 2.3%, Stage IIB in 21.7%, Stage III in 41.1%, Stage IVA in 14.9%, and Stage IVB in 9.1%. Of the 175 patients, 2 (1.2%), 10 (5.7%), and 163 (93.1%) had World Health Organization type I, II, and III histologic features, respectively. We prescribed 70 Gy, 60 Gy, and 54 Gy delivered in 33 fractions within 6.5 weeks at the periphery of three planning target volumes (PTV; PTV70, PTV60, and PTV54, respectively). Of the 175 patients, 46 with early T-stage disease received a brachytherapy boost, and 127 with advanced local or regional disease received chemotherapy.Results: The median follow-up period was 34 months. The overall 3-year local failure-free survival, regional failure-free survival, distant failure-free survival, and overall survival rate was 93.6%, 93.3%, 86.6%, and 87.2%, respectively. Cox regression analysis showed Stage N2-N3 disease (p = .029) and PTV (p = .024) to be independent factors predicting a greater risk of distant failure and poor overall survival, respectively. Grade 3 acute mucositis/pharyngitis occurred in 23.4% of patients, and Stage T4 disease was the only significant predictor of mucositis/pharyngitis (p = .021).Conclusion: Whole-field simultaneous integrated-boost intensity-modulated radiotherapy with a dose >70 Gy achieved excellent locoregional control, without an excess incidence of severe, acute mucositis/pharyngitis, in the present study. Strategies for using such highly conformal treatment for patients with a large tumor and late N-stage disease are potential areas of investigation for future studies. (C) 2010 Elsevier Inc.