Treatment Outcomes for Radiotherapy Alone are Comparable With Neoadjuvant Chemotherapy Followed by Radiotherapy in Early-Stage Nasopharyngeal Carcinoma
Treatment Outcomes for Radiotherapy Alone are Comparable With Neoadjuvant Chemotherapy Followed by Radiotherapy in Early-Stage Nasopharyngeal Carcinoma
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DOI：
10.1097/mlg.0b013e3181626cfe
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发表时间：
2008-04-01
期刊：
影响因子：
2.6
通讯作者：
Park, Charn Il
中科院分区：
文献类型：
--
作者：
Song, Chang Hoon;Wu, Hong-Gyun;Park, Charn Il
目的：分析新辅助化疗（CT）与单纯放疗（RT）对早期鼻咽癌（NPC）治疗的影响。我们回顾性分析了1986年至2004年在首尔国立大学医院接受单纯RT或新辅助CT后RT（CT/RT）治疗的60例既往未经治疗且经组织学证实的早期NPC患者的结局。新辅助CT包括3个周期的5-氟尿嘧啶和顺铂。鼻咽和颈部淋巴结接受RT。原发部位、受累淋巴结和选择性淋巴结的中位剂量分别为70.2戈伊、63戈伊和45戈伊。根据1997年美国癌症联合委员会分期系统，RT组中9例患者为I或IIA期疾病，22例患者为IIB期疾病。对于CT/RT组，8例患者患有I或IIA期疾病，21例患者患有IIB期疾病。所有患者的中位随访时间为124.5（范围，5 - 239）个月。RT组的5年无局部失败（LRFF）、无远处转移（DMF）、无病生存（DIPS）和总生存（OS）率分别为84%、93%、81%和84%，CT/RT组为77%、86%、71%和79%，分别RT和CT/RT组之间的LRFF（P =.728）、DMF（P =.433）、DFS（P =.562）和OS（P =.625）率无显著差异。多变量分析显示，延迟RT超过81天与IIB期疾病患者亚组局部失败风险增加显著相关（P = 0.044）。结论：在我们的回顾性分析中，新辅助CT的使用显示单独RT治疗没有额外的益处。新辅助CT可能通过延迟RT对IIB期疾病造成有害影响。
Objectives: To analyze the impact of neoadjuvant chemotherapy (CT) on the treatment of early-stage nasopharyngeal carcinoma (NPC) as compared with radiotherapy (RT) alone.Methods: We analyzed retrospectively the outcome of 60 previously untreated and histologically confirmed early-stage NPC patients treated with either RT alone or with neoadjuvant CT followed by RT (CT/RT) at the Seoul National University Hospital between 1986 and 2004. Neoadjuvant CT consisted of three cycles with 5-fluourouracil and cisplatin. RT was given to the nasopharynx and neck nodes. The median dose to the primary site, involved nodes, and elective nodes was 70.2 Gy, 63 Gy, and 45 Gy, respectively. According to the 1997 American Joint Committee on Cancer staging system, 9 patients had stage I or IIA disease, and 22 patients had stage IIB disease in the RT group. For the CT/RT group, 8 patients had stage I or IIA disease, and 21 patients had stage IIB disease. The median follow-up for all patients was 124.5 (range, 5-239) months.Results: The 5-year locoregional failure-free (LRFF), distant metastasis-free (DMF), disease-free survival (DIPS), and overall survival (OS) rate was 84%, 93%, 81%, and 84% for the RT group and 77%, 86%, 71%, and 79% for the CT/RT group, respectively. There were no significant differences in LRFF (P =.728), DMF (P =.433), DFS (P =.562), and OS (P =.625) rates between the RT and CT/RT groups. Multivariate analysis revealed that delaying RT for more than 81 days was, significantly associated with an increased risk of locoregional failure in the subgroup of patients with stage IIB disease (P =.044).Conclusions: In our retrospective analysis, the use of neoadjuvant CT showed no additional benefit to treatment with RT alone. Neoadjuvant CT may cause deleterious effect on stage IIB disease by delaying RT.