Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy.
Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy.
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DOI：
10.5732/cjc.010.10547
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发表时间：
2011-08
影响因子：
--
通讯作者：
Lu TX
中科院分区：
文献类型：
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作者：
Su SF;Han F;Zhao C;Huang Y;Chen CY;Xiao WW;Li JX;Lu TX
虽然有许多研究对鼻咽癌调强放射治疗（IMRT）进行了研究，但报道的研究样本量通常较小，并且很少分析不同T和N亚组的结局差异。在此，我们评估鼻咽癌患者接受调强放射治疗的结果，并进一步探讨改善这种结果的治疗策略。我们收集了865例接受调强放疗或调强放疗联合化疗的鼻咽癌患者的临床资料，并根据不同的TNM分期将所有病例分为以下预后类别：早期组（T1- 2N 0 - 1 M0）、晚期局部疾病组（T3- 4 N 0 - 1 M0）、晚期淋巴结疾病组（T1- 2N 2 - 3 M0）和晚期局部疾病组（T3- 4 N2 - 3 M0）。5年总生存率（OS）、局部无复发生存率（LRFS）和无远处转移生存率（DMFS）分别为83.0%、90.4%和84.0%。早期疾病组的治疗失败率最低，5年OS为95.6%。晚期局部疾病组和晚期淋巴结疾病组的失败模式和治疗结局相似，死亡风险比也相似（分别为4.230和4.625）。晚期局部疾病组的复发率和死亡率最高，5年的DFS和OS分别为62.3%和62.2%，死亡风险比为10.402。与单纯调强放疗相比，调强放疗联合化疗对局部晚期鼻咽癌无明显疗效。我们的研究结果表明，鼻咽癌患者的治疗策略的决定应考虑T和N阶段的组合，并单独调强放射治疗早期鼻咽癌患者可以产生满意的结果。然而，对于晚期局部、淋巴结和局部疾病组，建议联合化疗和放疗。
Although many studies have investigated intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), sample sizes in the reported studies are usually small and different in outcomes in different T and N subgroups are seldom analyzed. Herein, we evaluated the outcomes of NPC patients treated with IMRT and further explored treatment strategy to improve such outcome. We collected clinical data of 865 NPC patients treated with IMRT alone or in combination with chemotherapy, and classified all cases into the following prognostic categories according to different TNM stages: early stage group (T1–2N0–1M0), advanced local disease group (T3–4N0–1M0), advanced nodal disease group (T1–2N2–3M0), and advanced locoregional disease group (T3–4N2–3M0). The 5-year overall survival (OS), local relapse-free survival (LRFS), and distant metastases-free survival (DMFS) were 83.0%, 90.4%, and 84.0% respectively. The early disease group had the lowest treatment failure rate, with a 5-year OS of 95.6%. The advanced local disease group and advanced nodal disease group had similar failure pattern and treatment outcomes as well as similar hazard ratios for death (4.230 and 4.625, respectively). The advanced locoregional disease group had the highest incidence of relapse and death, with a 5-year DMFS and OS of 62.3% and 62.2%, respectively, and a hazard ratio for death of 10.402. Comparing with IMRT alone, IMRT in combination with chemotherapy provided no significant benefit to locoregionally advanced NPC. Our results suggest that the decision of treatment strategy for NPC patients should consider combinations of T and N stages, and that IMRT alone for early stage NPC patients can produce satisfactory results. However, for advanced local, nodal, and locoregional disease groups, a combination of chemotherapy and radiotherapy is recommended.