不同亚组鼻咽癌调强放疗等的远期临床转归与治疗策略

Long-term outcomes of patients with nasopharyngeal carcinoma in different stages treated by intensity-modulated radiotherapy and their treatment strategies

目的探讨鼻咽癌各亚组根治性调强放疗（IMRT）的远期临床转归与治疗策略。方法回顾分析2001--2008年间868例无远处转移鼻咽癌根治性IMRT等的生存资料，并将其分为早期N0（T1～2N0期137例）、早期N0（T1～2N0期129例）、局部晚期（T3～1N0-1期322例）、区域晚期（T1～2N2～3期107例）和局部加区域晚期（T3-4N2～3期173例）组，比较各组预后和不同治疗策略。结果随访率为91．4％，随访时间满5年者314例。全组5年总生存率、局部无复发率和无远处转移率（DMFR）分别为83．5％、91．8％和84．6％。T1-2N0期疗效最好，5年疾病特异生存率（DSS）高达99．1％；各组单纯IMRT与IMRT联合化疗疗效相似；T3～4N0-1期与T1-2N2-3期的失败模式和疗效相似；T3-4：N2-3期疗效最差，5年DMFR和DSS分别仅为67．2％和68．0％。T1-2N2-3T3-4N2-3期患者采用单纯IMRT、诱导化疗加IMRT或同期化疗加IMRT疗效相似。结论鼻咽癌不同亚组有不同的临床预后转归，建议采用不同治疗策略。T1-2N0期可单纯IMRT，其余各亚组，尤其是T3-4N2-3期组有较高的远处转移率，在IMRT基础上需进一步寻找和探讨更为有效的药物治疗方案。

Objective To investigate the long-term outcomes of patients with nasopharyngeal carcinoma （NPC） in different stages treated by intensity-modulated radiotherapy （IMRT） and explore their treatment strategies. Methods A retrospective analysis was performed on the clinical data of 868 NPC patients without distant metastasis who received radical IMRT from May 2001 to October 2008. These patients were divided into early NO （T1-2 No ） group （n = 137 ）, early N1 （T1-2 N1 ） group （n = 129 ）, locally advanced （T3-4 N0-I ） group （ n = 322 ）, regionally advanced （ T1-2 N2-3 ） group （ n = 107 ）, and loeoregionally advanced （T3 -4N2-3 ） group （n = 173 ）. There groups were compared in terms of treatment outcome and treatment strategy. Results The follow-up rate was 91.4%, and 314 patients completed 5- years follow-up. The 5-year overall survival rate, local recurrence-free rate, and distant metastasis-free rate （DMFR） were 83.5%, 91.8%, and 84. 6%, respectively. The early NO group had the best treatment outcome, with a 5-year disease-specific survival （ DSS ） rate up to 99. 1%. Each group had a similar outcome after receiving either IMRT alone or IMRT combined with chemotherapy. The locally advanced group and regionally advanced group had similar failure patterns and treatment outcomes. The loeoregionally advanced group had the worst treatment outcome, with a 5-year DMFR of 67.2% and a DSS of 68. 0%. The regionally advanced group and locoregionally advanced group had a similar treatment outcome after receiving IMRT alone , induction chemotherapy plus IMRT , or concurrent chemotherapy and IMRT . Conclusions Patients with NPC in different stages have different survival outcomes. It is recommended that different treatment strategies should be adopted according to the T and N stages of NPC. IMRT alone can produce satisfactory results in patients with T1 -2N0 NPC, but a more effective medication should be added to IMRT in patients with advanced NPC, particularly those with T3-4N2-3 NPC who have a relatively low DMFR.