Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Nasopharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy.
Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Nasopharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy.
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非转移性鼻咽癌患者接受调强质子治疗与调强放射治疗的毒性特征和生存结局
DOI：
10.1001/jamanetworkopen.2021.13205
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发表时间：
2021-06-01
影响因子：
13.8
通讯作者：
Lee NY
中科院分区：
文献类型：
--
作者：
Li X;Kitpanit S;Lee A;Mah D;Sine K;Sherman EJ;Dunn LA;Michel LS;Fetten J;Zakeri K;Yu Y;Chen L;Kang JJ;Gelblum DY;McBride SM;Tsai CJ;Riaz N;Lee NY
对于非转移性鼻咽癌（NPC）患者，调强质子治疗（IMPT）与调强放射治疗（IMRT）患者相比，是否与较少的治疗相关不良事件和相似的肿瘤学结局相关？在77例接受根治性放疗的非转移性NPC患者的队列研究中，与标准治疗IMRT相比，IMPT治疗的急性不良事件显著减少，晚期并发症罕见。倾向评分匹配分析显示两组的肿瘤学结局同样出色，包括IMPT组2年时100%的局部控制率。这些研究结果表明，IMPT作为非转移性NPC的潜在主要放疗方式时，应与患者进行讨论，因为它与IMRT相比，急性毒性负担较低，在局部控制中具有潜在的肿瘤学获益。本队列研究比较了新诊断的非转移性鼻咽癌（NPC）患者接受调强质子治疗（IMPT）与调强放疗（IMRT）联合或不联合化疗时的毒性反应和肿瘤学结局。非转移性鼻咽癌（NPC）患者主要通过放射治疗（有或无化疗）进行治疗，即使使用现代放射技术（如调强放射治疗（IMRT）），也经常出现大量治疗相关毒性反应。强度调制质子治疗（IMPT）可能会改善毒性特征;然而，由于IMPT在地方性NPC地区的可用性有限，因此数据匮乏。比较IMPT与IMRT联合或不联合化疗治疗新诊断的非转移性NPC患者的毒性反应和肿瘤学结局。这项回顾性队列研究纳入了77例新诊断的非转移性NPC患者，这些患者于2016年1月1日至2019年12月31日在三级学术癌症中心接受了IMPT或IMRT的治愈性放疗。48例EB病毒（EBV）阳性肿瘤患者被纳入1：1倾向评分匹配的生存结局分析。随访期结束于2021年3月31日。IMPT与IMRT联合或不联合化疗。主要结局是急性和慢性治疗相关不良事件（AE）的发生率和肿瘤学结局，包括局部无失败生存期（LRFS）、无进展生存期（PFS）和总生存期（OS）。我们确定了77例患者（25例[32.5%]女性; 52例[67.5%]男性;中位[四分位距]年龄为48.7 [42.2-60.3]岁），其中28例（36.4%）接受了IMPT治疗，49例（63.6%）接受了IMRT治疗。中位（四分位距）随访时间为30.3（17.9-41.5）个月。在多变量logistic回归分析中，IMPT与IMRT相比，发生2级或更高级别急性AE的可能性较低（比值比[OR]，0.15; 95%CI，0.03-0.60; P = 0.01）。IMPT组中仅1例（3.8%）慢性3级或以上AE，而IMRT组中有8例（16.3%）（OR，0.21; 95% CI，0.01-1.21; P = 0.15）。倾向评分匹配产生了48例患者的平衡队列（24例IMPT vs 24例IMRT），发现IMPT和IMRT组的PFS相似（2年PFS，95.7% [95% CI，87.7%-100%] vs 76.7% [95% CI，60.7%-97.0%];风险比[HR]，0.31; 95% CI，0.07-1.47; P = 0.14）。在匹配队列的IMPT组中未观察到局部复发或死亡。IMPT组的2年LRFS为100%（95% CI，100%-100%），IMRT组为86.2%（95% CI，72.8%-100%）（P = 0.08）。IMPT组的3年OS为100%（95% CI，100%-100%），IMRT组为94.1%（95% CI，83.6%-100%）（P = 0.42）。在多变量分析中，吸烟史是唯一与LRFS（HR，63.37; 95% CI，3.25-1236.13; P = .006）和PFS（HR，6.33; 95% CI，1.16-34.57; P = .03）不良显著相关的临床因素。在这项研究中，与IMRT相比，IMPT治疗非转移性NPC的治愈性放疗与显著降低的急性毒性负担相关，具有罕见的晚期并发症和良好的肿瘤学结局，包括2年时100%的局部控制。前瞻性试验是必要的，以指导最佳的患者选择IMPT作为非转移性NPC的主要放疗方式。
Is intensity-modulated proton therapy (IMPT) associated with fewer treatment-related adverse events and comparable oncologic outcomes for patients with nonmetastatic nasopharyngeal carcinoma (NPC) compared with patients treated with intensity-modulated radiation therapy (IMRT)? In this cohort study of 77 patients with nonmetastatic NPC treated with curative-intent radiotherapy, IMPT treatment was associated with significantly fewer acute adverse events compared with standard-of-care IMRT, with rare late complications. Propensity score–matched analysis demonstrated equally excellent oncologic outcomes in both groups, including 100% locoregional control rate at 2 years in the IMPT group. These findings suggest that IMPT should be discussed with patients as the potential primary radiotherapy modality for nonmetastatic NPC when it is available because it was associated with less acute toxicity burden compared with IMRT, with potential oncologic benefit in locoregional control. This cohort study compares toxic effects and oncologic outcomes among patients with newly diagnosed nonmetastatic nasopharyngeal carcinoma (NPC) when treated with intensity-modulated proton therapy (IMPT) vs intensity-modulated radiation therapy (IMRT) with or without chemotherapy. Patients with nonmetastatic nasopharyngeal carcinoma (NPC) are primarily treated by radiotherapy with curative intent with or without chemotherapy and often experience substantial treatment-related toxic effects even with modern radiation techniques, such as intensity-modulated radiation therapy (IMRT). Intensity-modulated proton therapy (IMPT) may improve the toxicity profile; however, there is a paucity of data given the limited availability of IMPT in regions with endemic NPC. To compare toxic effects and oncologic outcomes among patients with newly diagnosed nonmetastatic NPC when treated with IMPT vs IMRT with or without chemotherapy. This retrospective cohort study included 77 patients with newly diagnosed nonmetastatic NPC who received curative-intent radiotherapy with IMPT or IMRT at a tertiary academic cancer center from January 1, 2016, to December 31, 2019. Forty-eight patients with Epstein-Barr virus (EBV)–positive tumors were included in a 1:1 propensity score–matched analysis for survival outcomes. The end of the follow-up period was March 31, 2021. IMPT vs IMRT with or without chemotherapy. The main outcomes were the incidence of acute and chronic treatment-related adverse events (AEs) and oncologic outcomes, including locoregional failure-free survival (LRFS), progression-free survival (PFS), and overall survival (OS). We identified 77 patients (25 [32.5%] women; 52 [67.5%] men; median [interquartile range] age, 48.7 [42.2-60.3] years), among whom 28 (36.4%) were treated with IMPT and 49 (63.6%) were treated with IMRT. Median (interquartile range) follow-up was 30.3 (17.9-41.5) months. On multivariable logistic regression analyses, IMPT was associated with lower likelihood of developing grade 2 or higher acute AEs compared with IMRT (odds ratio [OR], 0.15; 95% CI, 0.03-0.60; P = .01). Only 1 case (3.8%) of a chronic grade 3 or higher AE occurred in the IMPT group compared with 8 cases (16.3%) in the IMRT group (OR, 0.21; 95% CI, 0.01-1.21; P = .15). Propensity score matching generated a balanced cohort of 48 patients (24 IMPT vs 24 IMRT) and found similar PFS in the IMPT and IMRT groups (2-year PFS, 95.7% [95% CI, 87.7%-100%] vs 76.7% [95% CI, 60.7%-97.0%]; hazard ratio [HR], 0.31; 95% CI, 0.07-1.47; P = .14). No locoregional recurrence or death was observed in the IMPT group from the matched cohort. Two-year LRFS was 100% (95% CI, 100%-100%) in the IMPT group and 86.2% (95% CI, 72.8%-100%) in the IMRT group (P = .08). Three-year OS was 100% (95% CI, 100%-100%) in the IMPT group and 94.1% (95% CI, 83.6%-100%) in the IMRT group (P = .42). Smoking history was the only clinical factor significantly associated with both poor LRFS (HR, 63.37; 95% CI, 3.25-1236.13; P = .006) and poor PFS (HR, 6.33; 95% CI, 1.16-34.57; P = .03) on multivariable analyses. In this study, curative-intent radiotherapy with IMPT for nonmetastatic NPC was associated with significantly reduced acute toxicity burden in comparison with IMRT, with rare late complications and excellent oncologic outcomes, including 100% locoregional control at 2 years. Prospective trials are warranted to direct the optimal patient selection for IMPT as the primary radiotherapy modality for nonmetastatic NPC.
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DOI：
10.1016/j.radonc.2011.05.028
发表时间：
2011-12
期刊：
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
影响因子：
--
作者：
Simone CB 2nd;Ly D;Dan TD;Ondos J;Ning H;Belard A;O'Connell J;Miller RW;Simone NL
通讯作者：
Simone NL
与需要同侧放射的头颈部肿瘤的调强放射治疗相比，质子束放射治疗的毒性显着降低。
DOI：
10.1016/j.radonc.2015.12.008
发表时间：
2016-02
期刊：
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
影响因子：
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