Local Control, Survival, and Late Toxicities of Locally Advanced Nasopharyngeal Carcinoma Treated by Simultaneous Modulated Accelerated Radiotherapy Combined With Cisplatin Concurrent Chemotherapy Long-Term Results of a Phase 2 Study
Local Control, Survival, and Late Toxicities of Locally Advanced Nasopharyngeal Carcinoma Treated by Simultaneous Modulated Accelerated Radiotherapy Combined With Cisplatin Concurrent Chemotherapy Long-Term Results of a Phase 2 Study
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DOI：
10.1002/cncr.25754
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发表时间：
2011-05-01
期刊：
影响因子：
6.2
通讯作者：
Zhao, Chong
中科院分区：
文献类型：
--
作者：
Xiao, Wei-Wei;Huang, Shao-Min;Zhao, Chong
背景：这项2期研究的目的是确定局部晚期鼻咽癌（NPC）患者接受调强放疗（IMRT）、同时调强加速放疗（SMART）加强技术和同步化疗的长期局部控制、生存和晚期毒性。方法：81例经病理诊断为局部晚期鼻咽癌患者纳入本研究。 IMRT 采用 SMART 增强技术以 68 戈瑞 (Gy)/30 分数的规定剂量递送至鼻咽总目标体积。同时进行顺铂化疗（第 1 天和第 22 天 80 mg/m(2)/d）。结果：递送至鼻咽总目标体积的平均实际物理剂量为73.8 Gy，鼻咽总目标体积的平均生物有效剂量（BED）为84.8 Gy。中位随访时间为 54 个月，4 名患者（4.9%）出现局部复发。 5年局部控制率为94.9%。十八名患者死亡。其中66.7%死于远处转移。 5年无病生存率和总生存率分别为76.7%和74.5%。在 68 名随访时间≥4 年的患者中，最常见的晚期毒性是 1-2 级口干症、听力损失、皮肤营养不良和皮下纤维化。未发现 4 级晚期毒性。结论：IMRT 联合 SMART 增强 BED 和同步化疗对于局部晚期鼻咽癌患者是可行的。长期结果显示，局部控制良好，后期毒性较少，但总体生存率没有进一步改善，死亡的主要原因是远处转移。有必要探索更有效的联合放化疗策略。癌症 2011；117：1874-83。 (C) 2010 年美国癌症协会。
BACKGROUND: The aim of this phase 2 study was to determine the long-term local control, survival, and late toxicities among patients with locally advanced nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) with the simultaneous modulated accelerated radiation therapy (SMART) boost technique and concurrent chemotherapy. METHODS: Eighty-one patients with pathologically diagnosed locally advanced NPC were enrolled in this study. IMRT was delivered with the SMART boost technique at prescribed doses of 68 grays (Gy)/30 fraction to the nasopharynx gross target volume. Concurrent cisplatin chemotherapy (80 mg/m(2)/d on Days 1 and 22) was administered. RESULTS: The mean actual physical dose delivered to the nasopharynx gross target volume was 73.8 Gy, and the mean biologically effective dose (BED) for the nasopharynx gross target volume was 84.8 Gy. With a median follow-up of 54 months, 4 (4.9%) patients experienced local recurrence. The 5-year local control rate was 94.9%. Eighteen patients died. Among them, 66.7% died of distant metastasis. The 5-year disease-free and overall survivals were 76.7% and 74.5%, respectively. The most common late toxicities among 68 patients with >= 4 years follow-up were grade 1-2 xerostomia, hearing loss, skin dystrophy, and subcutaneous fibrosis. No grade 4 late toxicities were noted. CONCLUSIONS: IMRT with SMART to enhance BED and concurrent chemotherapy is feasible in patients with locally advanced NPC. Long-term results showed excellent local control with fewer late toxicities, although no further improvement was noted in overall survival, and the major cause of death was distant metastasis. Exploration of more effective combined chemoradiation strategies is warranted. Cancer 2011;117:1874-83. (C) 2010 American Cancer Society.