339例鼻咽癌调强放疗临床疗效分析

Intensity-modulated Radiation Therapy for Nasopharyngeal Carcinoma:Treatments and Outcomes in a Monoinstitutional Experience

目的:评价本院鼻咽癌调强放疗的初步临床疗效。方法:回顾分析2006年6月至2010年12月采用调强放疗的首程无转移鼻咽癌患者临床结果。采用Kaplan-Meier法进行生存分析,Cox回归模型进行多因素分析评价预后因子,RTOG/EORTC标准评价急性放疗反应和晚期损伤。结果:339例初治鼻咽癌患者,男性244例,女性95例,男:女比例为2.57:1,中位年龄44岁。中位随访时间为22.5个月,随访率为97.3%。全组1、2、3年总生存率分别为99.0%、94.9%、90.7%;疾病特异生存率分别为99.1%、97.0%、94.2%;无瘤生存率分别为96.4%、92.9%、86.4%;局部控制率分别为98.1%、96.5%、95.7%;区域控制率分别为99.3%、98.5%、97.8%;无远处转移生存率分别为97.1%、93.6%、88.1%。Cox多因素分析显示临床分期(Ⅰ～Ⅲ期vs.Ⅳ期)和年龄(<44岁vs.≥44岁)是总生存、无瘤生存和无远处转移生存的独立预后因子;临床分期是疾病特异生存的独立预后因子。常见急性放疗不良反应为1、2级皮肤损伤(98.8%)及2、3级口腔黏膜损伤(95.0%)。随访超过2年的患者中12例仍存在1、2级腮腺损伤,未观察到3、4级晚期损伤。结论:IMRT治疗首程无转移鼻咽癌患者可获得较好的局部区域控制及总生存率,对正常器官有较好的保护作用,急性不良反应可较好耐受,远处转移是治疗失败的主要模式。

Objective： This study aims to report a monoinstitutional experience with the use of intensity-modulated radiotherapy （IMRT） for nasopharyngeal carcinoma （NPC）. Methods： Between June 2006 and December 2010, 339 consecutive histology-proven NPC patients treated with IMRT had a median follow-up of 22.5 months. The effects of multiple clinical and treatment parameters on the evaluated survival parameters were determined. Results： A total of 339 patients with NPC treated with IMRT were included, among which 244 were males and 95 were females （gender ratio, 2.57：1）, with a median age of 44 years （range, 13 to 78 years）. According to the AJCC/UICC 2010 classification, 76.1% of the patients had Stage III/IV disease. The 1-, 2- and 3-year overall survival （OS） was 99.0%, 94.9%, 90.7%, disease-specific survival （DSS） was 99.1%, 97.0%, 94.2%, disease-free survival （DFS） was 96.4%, 92.9%, 86.4%, local control was 98.1%, 96.5%, 95.7%, regional control was 99.3%, 98.5%, 97.8%, and metastasis-free survival （MFS） was 97.1%, 93.6%, 88.1%, Through Cox multivariate analysis, the age （〈44 years vs. ≥144 years） and the clinical stage （ I to III vs. IV） were found to have predictive values for OS, DFS, and MFS, whereas the late clinical stage （IVA to IVB） was found to be the independent predictor of poor DSS. The most common acute toxicities included Grades I to II skin reaction in 335 patients （98.8%） and Grades II to III oral mucositis in 322 patients （95.0%）. After 2 years of IMRT, 12 patients had Grades I to II xerostomia （10.4%）. No Grades III or IV xerostomia was detected. Conclusions： The use of IMRT is associated with excellent loco-regional control and overall survival. Acute toxicity is common and acceptable. Distant metastasis remains the most difficult challenge, and more effective systemic regimens should be tailored for patients with high risk factors.