Intensity modulated radiotherapy (IMRT) combined with concurrent but not adjuvant chemotherapy in primary nasopharyngeal cancer - a retrospective single center analysis.
Intensity modulated radiotherapy (IMRT) combined with concurrent but not adjuvant chemotherapy in primary nasopharyngeal cancer - a retrospective single center analysis.
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DOI：
10.1186/1748-717x-8-20
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发表时间：
2013-01-24
期刊：
影响因子：
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通讯作者：
Roeder F
中科院分区：
文献类型：
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作者：
Saleh-Ebrahimi L;Zwicker F;Muenter MW;Bischof M;Lindel K;Debus J;Huber PE;Roeder F
我们报告了49例鼻咽癌患者接受调强放射治疗（IMRT）联合同期但非辅助化疗（CHT）的经验。回顾性分析了49例经组织学证实的原发性鼻咽癌患者的病历，这些患者接受了调强放疗和同期铂类药物为主的CHT（主要是顺铂，每周一次）治疗。大多数患者表现为晚期临床分期（III/IV期：72%），组织学未分化（82%）。84%的患者采用分步照射技术进行调强放射治疗。在这个概念中，加强体积覆盖原发肿瘤和涉及的淋巴结，剂量为66-70.4戈伊（单次剂量2.2戈伊）。未累及的区域淋巴结区域覆盖剂量为54-59.4戈伊（单次剂量中位数为1.8戈伊）。至少有一个腮腺被保留下来。没有患者接受辅助CHT。整个队列的中位随访时间为48个月。所有患者均完成了放射治疗，无中断，76%的患者接受了至少80%的计划CHT。观察到4例局部复发，转入1年、3年和5年局部控制（LC）率分别为98%、90%和90%。1例患者出现孤立性区域淋巴结复发，导致1年、3年和5年区域控制（RC）率为98%。所有局部失效均位于辐射野内。6例患者发现远处转移，转移到1年、3年和5年的远处控制（DC）率分别为92%、86%和86%。1年、3年和5年后的无进展生存期（PFS）率分别为86%、70%和69%，1年、3年和5年总生存期（OS）率分别为96%、82%和79%。≥ III级的急性毒性反应主要为吞咽困难（32%）、白细胞减少（24%）、口腔炎（16%）、感染（8%）和恶心（8%）。18%的患者记录了严重的晚期毒性（III级），主要表现为口干症（10%）。采用IMRT结合整体加强概念进行同步放化疗，不增加辅助化疗周期，在原发性鼻咽癌患者中获得了良好的疾病控制和总生存率，急性副作用可接受，晚期毒性发生率有限。
We report our experience in 49 consecutive patients with nasopharyngeal carcinoma who were treated by Intensity-modulated radiation therapy (IMRT) combined with simultaneous but not adjuvant chemotherapy (CHT). The medical records of 49 patients with histologically proven primary nasopharygeal carcinoma treated with IMRT and concurrent platin-based CHT (predominantly cisplatin weekly) were retrospectively reviewed. The majority of patients showed advanced clinical stages (stage III/IV:72%) with undifferentiated histology (82%). IMRT was performed in step-and-shoot technique using an integrated boost concept in 84%. In this concept, the boost volume covered the primary tumor and involved nodes with doses of 66–70.4 Gy (single dose 2.2 Gy). Uninvolved regional nodal areas were covered with doses of 54–59.4 Gy (median single dose 1.8 Gy). At least one parotid gland was spared. None of the patients received adjuvant CHT. The median follow-up for the entire cohort was 48 months. Radiation therapy was completed without interruption in all patients and 76% of the patients received at least 80% of the scheduled CHT. Four local recurrences have been observed, transferring into 1-, 3-, and 5-year Local Control (LC) rates of 98%, 90% and 90%. One patient developed an isolated regional nodal recurrence, resulting in 1-, 3-, and 5-year Regional Control (RC) rates of 98%. All locoregional failures were located inside the radiation fields. Distant metastases were found in six patients, transferring into 1-, 3, and 5-year Distant Control (DC) rates of 92%, 86% and 86%. Progression free survival (PFS) rates after 1, 3 and 5 years were 86%, 70% and 69% and 1-, 3- and 5-year Overall Survival (OS) rates were 96%, 82% and 79%. Acute toxicity ≥ grade III mainly consisted of dysphagia (32%), leukopenia (24%), stomatitis (16%), infection (8%) and nausea (8%). Severe late toxicity (grade III) was documented in 18% of the patients, mainly as xerostomia (10%). Concurrent chemoradiation without the addition of adjuvant chemotherapy cycles using IMRT with an integrated boost concept yielded good disease control and overall survival in patients suffering from primary nasopharyngeal cancer with acceptable acute side effects and limited rates of late toxicity.