Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: Update of the memorial Sloan-Kettering experience
Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: Update of the memorial Sloan-Kettering experience
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DOI：
10.1016/j.ijrobp.2005.03.057
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发表时间：
2006-01-01
影响因子：
7
通讯作者：
Zelefsky, MJ
中科院分区：
文献类型：
--
作者：
Wolden, SL;Chen, WC;Zelefsky, MJ
目的：我们以前证明，调强放射治疗（IMRT）显着改善辐射剂量分布的三维规划鼻咽癌和积极的早期临床结果报告。现在，我们评估是否IMRT已导致改善的结果为一个更大的队列的患者较长follow-up.Methods和材料：自1998年以来，所有74例新诊断的，非转移性鼻咽癌与IMRT治疗使用加速分割到70戈伊; 59人接受了超分割伴随升压，最近15日接受一次剂量绘画治疗。除I期疾病（n = 5）和患者偏好（n = 1）外，69例患者接受了与Intergroup 0099试验相似的同时和辅助铂类化疗。6% I期，16% II期，30% III期，47% IV期。中位随访时间为35个月。3年局部控制率为91%，区域控制率为93%; 3年无远处转移率、无进展生存率和总生存率分别为78%、67%和83%。T1/T2期疾病的局部控制率为100%，而T3/T4期疾病为83%（p = 0.01）。6例患者在原发部位失败，局部肿瘤进展的中位时间为16个月; 5例仅在70戈伊体积内，1例在靶体积内外。与1998年之前接受三维计划和化疗的35例患者的79%局部控制相比，IMRT的局部控制有改善的趋势（p = 0.11）。治疗后6个月，随访听力图的患者（n = 24例患者）分别有21%、13%、15%和0%的1、2、3和4级感音神经性听力损失。随访> 1年的患者（n = 59），长期口干发生率为：无26%，1级42%，2级32%，3级0例。结论：靶体积内原发部位失败的模式提示局部晚期T期疾病可能需要更高的生物剂量。由于对正常组织的保护，IMRT的严重（3-4级）耳毒性和口干症发生率较低。远处转移现在是失败的主要形式，强调需要改进的系统治疗。(c)2006年爱思唯尔公司
Purpose: We previously demonstrated that intensity-modulated radiation therapy (IMRT) significantly improves radiation dose distribution over three-dimensional planning for nasopharynx cancer and reported positive early clinical results. We now evaluate whether IMRT has resulted in improved outcomes for a larger cohort of patients with longer follow-up.Methods and Materials: Since 1998, all 74 patients with newly diagnosed, nonmetastatic nasopharynx cancer were treated with IMRT using accelerated fractionation to 70 Gy; 59 received a hyperfractionated concomitant boost, and more recently 15 received once-daily treatment with dose painting. With the exception of Stage I disease (n = 5) and patient preference (n = 1), 69 patients received concurrent and adjuvant platinum-based chemotherapy similar to that in the Intergroup 0099 trial.Results: Patient characteristics: median age 45; 32% Asian; 72% male; 65% World Health Organization III; 6% Stage I, 16% Stage II, 30% Stage III, 47% Stage IV. Median follow-up is 35 months. The 3-year actuarial rate of local control is 91%, and regional control is 93%; freedom from distant metastases, progression-free survival, and overall survival at 3 years are 78%, 67%, and 83%, respectively. There was 100% local control for Stage T1/T2 disease, compared to 83% for T3/T4 disease (p = 0.01). Six patients failed at the primary site, with median time to local tumor progression 16 months; 5 were exclusively within the 70 Gy volume, and I was both within and outside the target volume. There is a trend for improved local control with IMRT when compared to local control of 79% for 35 patients treated before 1998 with three-dimensional planning and chemotherapy (p = 0.11). Six months posttherapy, 21%, 13%, 15%, and 0% of patients with follow-up audiograms (n = 24 patients) had Grade 1, 2, 3, and 4 sensorineural hearing loss, respectively. For patients with > 1 year follow-up (n = 59), rates of long-term xerostomia were as follows: 26% none, 42% Grade 1, 32% Grade 2, and zero Grade 3.Conclusions: The pattern of primary site failure within the target volume suggests locally advanced T stage disease may require a higher biologic dose to gross tumor. Rates of severe (Grade 3-4) ototoxicity and xerostomia are low with IMRT as a result of normal-tissue protection. Distant metastases are now the dominant form of failure, emphasizing the need for improved systemic therapy.(c) 2006 Elsevier Inc.