儿童及青少年鼻咽癌调强放射治疗联合化疗疗效分析

Efficacy of intensity-modulated radiotherapy combined with chemotherapy for nasopharyngealcarcinoma in children and adolescents

目的 回顾性分析儿童及青少年鼻咽癌调强放射治疗和化疗的治疗结果及不良反应。方法 收集2010年4月至2016年4月治疗的〈19岁鼻咽癌患者43例。所有入组患者均接受调强放射治疗（IMRT）和基于铂类的化疗，放疗总剂量61.2-76 Gy。计算总生存（OS）时间和无进展生存（PFS）时间；分析患者临床特征及治疗的不良反应和远期并发症。结果 入组患者中位年龄14岁（6-18岁），≤14岁患者28例（65.1%），男性29例（67.4%），女性14例（32.6%），100%患者为非角化型癌。根据美国癌症分期联合委员会第7版，Ⅱ期2例（4.6%），Ⅲ期26例（60.5%），ⅣA期7例（16.3%），ⅣB期8例（18.6%）。治疗前EB病毒依壳抗原IgA抗体阳性率53.8%（7/13），Rta-IgG抗体阳性率60.0%（6/10）。IMRT中位剂量70 Gy（61.2-76 Gy），33例患者（76.7%）接受诱导化疗，20例（46.5%）采用同步放化疗，36例（83.7%）接受了辅助化疗。中位随访24个月（3-76个月），5年OS和PFS分别为75.3%和64.7%，5例（11.6%）患者治疗后2年内出现骨转移，47.4%（9/19）患者IMRT后促甲状腺激素（TSH）增高或伴有T3、T4减低。结论 儿童及青少年鼻咽癌特点为肿瘤分化差，临床分期晚，能够耐受放化综合治疗。骨转移是最常见的治疗失败模式，放疗后甲状腺功能减退较为常见。

Objective To evaluate the treatment outcomes and toxicities of intensity-modulated radiation therapy （IMRT） combined with chemotherapy for children and adolescents with nasopharyngeal carcinoma.Methods Forty-three nasopharyngeal carcinoma patients less than 19 years old were recruited between April 2010 and April 2016. All patients were treated with IMRT （total dose 61.2-76 Gy） combined with cisplatin based chemotherapy. The Kaplan-Meier test was used to calculate overall survival （OS） and progression-free survival （PFS）. The patient＇s clinical characteristics, side effects and long-term effects of treatment were retrospectively analyzed. Results Among 43 patients, there were 29 （67.4%） male and 14 （32.6%） female, and the median age was 14 years old （range, 6-18 years）. According to AJCC 7th staging system, 2 patients were in stage Ⅱ, 26 in stage Ⅲ, 7 in stage ⅣA and 8 in stage ⅣB. All patients were confirmed as non-keratinizing carcinoma. The positive rates of EB virus VCA-IgA was 53.8% （7/13）, and Rta-IgG was 60.0% （6/10） before treatment. The median radiation dose was 70 Gy （range, 61.2-76 Gy） to the primary tumor. Thirty-three （76.7%） patients received neoadjuvant chemotherapy, with 20 （46.5%） and 36 （83.7%） patients treated by concurrent and adjuvant chemotherapy, respectively. With a median follow-up of 24 months （range, 3-76 months）, the 5-year OS and PFS ratios were 75.3% and 64.7%, respectively. There were 5 patients （11.6%） occured to bone metastasis within 2 years after treatment. Hypothyroidism was reported in 47.4% （9/19） patients after IMRT. Conclusions Nasopharyngeal carcinoma in childhood and adolescence is mostly locally advanced diseases with poor differentiation. IMRT combined with chemotherapy produce a well treatment outcome with good tolerance in children and adolescents patients. The most common treatment failure bone metastasis. Radiation-induced hypothyroidism is common.