Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma Treatment results and locoregional recurrence
Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma Treatment results and locoregional recurrence
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DOI：
10.1007/s00066-013-0429-8
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发表时间：
2013-12-01
影响因子：
3.1
通讯作者：
Wang, C. -W.
中科院分区：
文献类型：
--
作者：
Chen, J. L. -Y.;Huang, Y. -S.;Wang, C. -W.
本研究的目的是观察T4期鼻咽癌（NPC）患者接受调强放射治疗（IMRT）后的疗效。2007年至2010年，154例非转移性T4期NPC患者接受了IMRT治疗，总剂量为70戈伊，分33-35次。此外，97%的患者同时接受含铂化疗。中位随访时间为52.8个月，5年精确局部控制率、无远处转移生存率、无进展生存率和总生存率（OS）分别为81.2%、72.2%、61.9%和78.1%。共有27例患者出现局部复发：85.2%为场内失败，11.1%为边缘失败，3.7%为场外失败。14例局部复发患者接受了积极治疗，包括鼻咽切除术、颈淋巴结清扫术或再放疗，5年OS率（61.9%）往往优于接受保守治疗的患者（32.0%，p = 0.051）。在接受1个疗程放疗的患者中，耳毒性、颈部纤维化、口干、鼻衄和放射学颞叶坏死的a级毒性分别发生在18.2%、9.8%、6.3%、2.1%和5.6%的患者中。在接受再照射的患者中观察到耳毒性增加、骨坏死、严重鼻出血和颞叶坏死。调强放射治疗对T4鼻咽癌患者提供了良好的局部控制。对于明确放疗后局部复发的患者，积极的局部治疗可能会获得更好的结果。
The purpose of this work was to examine outcomes in patients with T4 nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).Between 2007 and 2010, 154 patients with nonmetastatic T4 NPC were treated with IMRT to a total dose of 70 Gy in 33-35 fractions. In addition, 97 % of patients received concurrent platinum-based chemotherapy. The median follow-up time was 52.8 months.The rates of 5-year actuarial locoregional control, distant metastasis-free survival, progression free-survival, and overall survival (OS) were 81.2, 72.2, 61.9, and 78.1 %, respectively. A total of 27 patients had locoregional recurrence: 85.2 % in-field failures, 11.1 % marginal failures, and 3.7 % out-of-field failures. Fourteen patients with locoregional recurrence received aggressive treatments, including nasopharyngectomy, neck dissection, or re-irradiation, and the 5-year OS rate tended to be better (61.9 %) compared to those receiving conservative treatment (32.0 %, p = 0.051). In patients treated with 1 course of radiotherapy, grade a parts per thousand yenaEuro parts per thousand 3 toxicities of ototoxicity, neck fibrosis, xerostomia, epistaxis, and radiographic temporal lobe necrosis occurred in 18.2, 9.8, 6.3, 2.1, and 5.6 % of patients, respectively. Increased ototoxicity, osteonecrosis, severe nasal bleeding, and temporal necrosis were observed in patients treated by re-irradiation.IMRT offers good locoregional control in patients with T4 NPC. For patients with locoregional recurrence after definitive radiotherapy, aggressive local treatment may be considered for a better outcome.