NASOPHARYNGEAL CARCINOMA TREATED WITH REDUCED-VOLUME INTENSITY-MODULATED RADIATION THERAPY: REPORT ON THE 3-YEAR OUTCOME OF A PROSPECTIVE SERIES
NASOPHARYNGEAL CARCINOMA TREATED WITH REDUCED-VOLUME INTENSITY-MODULATED RADIATION THERAPY: REPORT ON THE 3-YEAR OUTCOME OF A PROSPECTIVE SERIES
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DOI：
10.1016/j.ijrobp.2008.12.015
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发表时间：
2009-11-15
影响因子：
7
通讯作者：
Lu, Jiade J.
中科院分区：
文献类型：
--
作者：
Lin, Shaojun;Pan, Jianji;Lu, Jiade J.
目的：评估使用缩小临床靶体积（CTV）的调强放疗（IMRT）治疗鼻咽癌（NPC）的疗效。方法和材料：2003年8月至2006年12月期间，根据本机构方案对323名NTC患者进行了IMRT治疗。 63 名患者处于 II 期，166 名患者处于 III 期，94 名患者处于 IVA/B 期。高危CTV包括大体肿瘤体积和带有边缘的整个鼻咽粘膜。与原发疾病相邻的剩余亚临床区域的 CTV 降低。根据放射治疗肿瘤学组 (RTOG)/欧洲癌症研究与治疗组织 (EORTC) 共识，勾画未受累颈部淋巴结，不包括颈深静脉（即 C1 椎骨上方茎突间隙中的淋巴结）和颏下淋巴结。局部晚期疾病患者也接受了以顺铂为基础的化疗。结果：中位随访30个月（范围4-53个月），分别有12、6和26名患者出现局部、区域和远处失败。 3年估计局部控制、区域控制、无转移生存率、无病生存率和总生存率分别为95%、98%、90%、85%和90%。多变量分析显示，T 分类对结果没有预测价值，而 N 分类对于预测无转移 (p = 0.005) 和总生存 (p = 0.006) 具有重要意义。 10 名患者 (7.8%) 在治疗 24 个月后出现 II 级口干症。未观察到 III 级或 IV 级后期毒性。两名患者死于治疗引起的并发症。结论：使用缩小靶体积的 IMRT 方法为 NPC 提供了良好的结果，且毒性可接受。该策略需要优化，然后在前瞻性环境中进行测试，以了解是否可以实现进一步的改进。 (C) 2009 爱思唯尔公司。
Purpose: To evaluate the efficacy of intensity-modulated radiotherapy (IMRT) using reduced clinical target volumes (CTV) in the treatment of nasopharyngeal carcinoma (NPC).Methods and Materials: Between August 2003 and December 2006,323 patients with NTC were treated with IMRT according to this institutional protocol. Presenting stages were Stage II in 63, Stage III in 166, and Stage IVA/B in 94 patients. High-risk CTV encompassed gross tumor volume and entire nasopharyngeal mucosa with a margin. A reduced CTV was delineated for the remaining subclinical regions adjacent to the primary disease. Uninvolved neck nodes were delineated according to the Radiation Therapy Oncology Group (RTOG) / European Organisation for Research and Treatment of Cancer (EORTC) consensus excluding the deep jugular (i.e., lymph nodes in retrostyloid space above C1 vertebra) and submental nodes. Patients with locoregionally advanced diseases also received cisplatin-based chemotherapy.Results: With a median follow-up of 30 months (range, 4-53months), 12, 6, and 26 patients had developed local, regional, and distant failures, respectively. The 3-year estimated local control, regional control, metastasis-free survival, disease-free survival and overall survival were 95%, 98%, 90%, 85%, and 90%, respectively. Multivariate analyses revealed that T-classification had no predictive value for outcome, whereas N-classification was significant for predicting metastasis-free (p = 0.005) and overall survival (p = 0.006). Ten patients (7.8%) experienced Grade II xerostomia at 24 months after treatment. No Grade III or IV late-toxicities were observed. Two patients died of treatment-induced complications.Conclusion: The IMRT approach using a reduced target volume provided favorable outcome for NPC with acceptable toxicity. This strategy needs to be optimized and then tested in a prospective setting to learn whether further improvement can be achieved. (C) 2009 Elsevier Inc.