Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy
Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy
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DOI：
10.7150/jca.17858
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发表时间：
2017-01-01
影响因子：
3.9
通讯作者：
He, Xiayun
中科院分区：
文献类型：
--
作者：
Xue, Fen;Hu, Chaosu;He, Xiayun
目的：方法：回顾性分析2005年1月至2010年12月间275例接受调强放疗（IMRT）治疗的非转移性鼻咽癌患者的远期局部失败情况。分期为II（淋巴结直径大于等于4 cm）、III或IV的患者也接受化疗。失败被评估为相对于治疗前计划计算机断层扫描数据集的场内或场外。采用考克斯比例风险模型分析各预后因素对局部无失败生存期（RFFS）和总生存期（OS）的影响。结果：中位随访71个月，RFFS和OS率分别为94.3%和83.9%。17例患者出现区域性失败，其中16例为场内失败; 1例患者腮腺出现外场失败，Ib级未见复发。II级和咽后区的失败分别占所有失败的70.6%（12/17）和52.9%（9/17）。N 0 -1和N2-3分类患者的5年RFFS率分别为98.5%和90.2%（p = 0.001）。多因素分析显示，N分期是RFFS的唯一独立预后因素（HR 7.363，95%CI 1.516-35.756，p = 0.013）。结论：鼻咽癌调强放疗后局部放疗失败并不常见，但N2-3期患者的局部放疗失败率明显高于N 0 -1期患者。射野内失败是局部复发的主要模式，最常在II级和咽后区检测到，而射野外失败很少见。应密切关注晚期N期NPC患者。
Purpose: To analyze the long-term patterns of regional failure following intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods: From January 2005 to December 2010, 275 non-metastatic NPC patients treated with IMRT were retrospectively enrolled. Patients staged as II (lymph nodes measuring 4 or more cm in diameter), III or IV also received chemotherapy. Failures were assessed as in-field or out-field relative to the pretreatment planning computed tomography data sets. Univariate and multivariate analyses were performed with Cox proportional hazards model to analyze the effect of various prognostic factors on regional failure-free survival (RFFS) and overall survival (OS).Results: During a median follow-up of 71 months, the RFFS and OS rates were 94.3% and 83.9%, respectively. Seventeen patients developed regional failures, of which 16 were in-field; one patient showed an out-field failure in the parotid gland, and no recurrences were seen for level Ib. Failures in level II and in the retropharyngeal area accounted for 70.6% (12/17) and 52.9% (9/17) of all failures, respectively. The 5-year RFFS rates for patients with classifications of N0-1 and N2-3 were 98.5% and 90.2%, respectively (p = 0.001). Multivariate analysis showed that N stage was the only independent prognostic predictor of RFFS (HR 7.363, 95% CI 1.516-35.756, p = 0.013).Conclusions: The regional failure of NPC after treatment with IMRT is uncommon but is significantly higher in N2-3 patients than in N0-1 patients. In-field failures represent the main pattern of regional recurrence and are most often detected in level II and in the retropharyngeal area, while out-field failure is rare. Close attention should be directed to NPC patients with advanced N stages.