摘要
目的 报道初治鼻咽癌调强放疗（IMRT）的长期随访结果并分析影响预后的因素.方法 419例初治鼻咽癌接受全程IMRT.UICC/AJCC2002分期Ⅰ、Ⅱ、Ⅲ和Ⅳ期分别为28、113、202和76例.182例单纯放疗,237例放化疗.放疗处方剂量：鼻咽大体肿瘤靶区66～70 Gy分25～30次,颈部淋巴结大体肿瘤靶区60～64 Gy分25～30次,临床靶区155～62 Gy分25～30次,临床靶区242～54 Gy分25～30次.结果 随访6～94个月,随访满5年患者166例.局部复发21例,区域复发13例,远处转移57例.5年局部控制率、区域控制率和无远处转移率分别为92.7%、95.8%和85.5%.5年无瘤生存率（DFS）、疾病特异生存率（DSS）和总生存率分别为76.3%、84.4%和83.3%.单因素分析显示T早期、疗前原发肿瘤体积≤20 cm^3、N早期、疗前颈淋巴结体积≤5 cm^3患者5年DFS和DSS优于各自对应项[84.1%：67.6%（χ~2=12.16,P：0.000）和92.1%：75.1%（χ^2=14.86,P=0.000）;89.1%：62.9%（χ^2=14.13,P=0.000）和96.2%：72.1%,（χ^2=38.76,P=0.000）;81.1%：64.5%（χ^2=15.49,P=0.000）和87.8%：76.1%（χ^2=10.89,P=0.001）;83.3%：68.8%（χ^2=14.13,P=0.000）和90.0%：78.1%（χ^2=10.71,P=0.001）].多因素分析显示疗前原发肿瘤体积、N分期是DFS和DSS的独立预后因素（χ^2=26.81,P=0.000,χ^2=4.92,P=0.026和χ^2=28.47,P=0.000,χ^2=9.50,P=0.002）.全组未观察到4级急性和晚期副反应;随访满3年以上的243例患者中,3级晚期毒副反应发生率仅为2.8%.结论 IMRT±化疗提高了初治鼻咽癌的长期疗效,尤其提高了局部和区域控制率.远处转移已成为治疗失败的最主要原因.疗前原发肿瘤体积和N分期是影响生存的主要因素.IMRT±化疗的急性副反应可耐受,晚期副反应轻微.
Objective To investigate the long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy （IMRT）. Methods From February 2001 to December 2006, 419 patients with nasopharyngeal carcinoma in Cancer Center of Sun yat-sen University received IMRT. The number of patients with stage I , II ,III and IV disease was 28, 113, 202 and 76, respectively. In all, 182 and 237 patients received radiotherapy alone and chemoradiotherapy. The prescription doses were as follows：66 -70 Gy/25 -30 f to GTVnx, 60 -64 Gy/25 -30 f to GTVno, 55 -62 Gy/25 -30 f to CTVI , and 42 -54 Gy/25 -30 f to CTV2. Results The median follow-up time was 49 months （6 -94 months）. The number of patients with follow-up of 1-, 3-, and 5-year were 419,360 and 166, respectively. Twenty-one, 13 and 57 patients had local recurrence, regional recurrence and distant metastasis, respectively. The 5-year local control （LC） rate, regional control （RC） rate and free from distant metastasis survival rate was 92.7% , 95.8% and 85.5% , respectively. The 5-year disease-free survival （DFS） and disease-specific survival （DSS） was 76. 3% and 84.4%, respectively. In univariate analysis, T stage, primarytumor volume, N stage and volume of cervical nodes before treatment were significant predictors of DFS and DSS, favoring the patients with early T stage （84. 1% vs. 67. 6% , χ^2 = 12. 16, P = 0. 000 ; 92. 1% vs. 75. 1% , χ^2 = 14. 86 , P = 0. 000 ） , primary tumor volume less than 20 cm^3 （89. 1% vs. 62.9%,χ^2=14.13,P=0.000;96.2% vs. 72. 1%,χ^2=38.76,P=0.000）, early N stage （81.1% vs. 64.5%,χ^2=15.49,P=0.000;87.8% vs. 76. 1%,χ^2=10.89,P=0.001） and volume of cervical nodes less than 5 cm^3 （ 83.3% vs. 68.8% ,χ^2= 14. 13, P = 0. 000; 90. 0% vs. 78. 1%, χ^2= 10. 71 ,P = 0. 001 ）. Multivariate analysis showed that primary tumor volume （ X2 = 26. 81, P = 0. 000 and χ^2 = 28.47,P = 0. 000） and N stage （χ^2 = 4. 92, P = 0. 026 and χ^2= 9. 50, P = 0. 002 ） were independent predictive factors for both DFS and DSS. No grade 4 acute and late toxicities were observed. In 243 patients with follow-up time more than 3 years, only 2. 8% suffered from grade 3 late toxicities. Conclusions IMRT with or without chemotherapy can improve the long-term survival of patients with nasopharyngeal carcinoma, especially in LC and RC. Distant metastasis becomes the main treatment failure. Primary tumor volume and N stage are significant prognostic factors. Acute and late toxicities are acceptable.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2010年第3期191-196,共6页
Chinese Journal of Radiation Oncology
基金
广东省科技计划项目（20078031516004）
关键词
鼻咽肿瘤/放射疗法
放射疗法
调强
预后分析
Nasopharyngeal neoplasms/radiotherapy
Radiotherapy, intensity modulated
Prognostic analysis
