初治寡转移鼻咽癌患者原发灶根治性放疗疗效分析

Efficacy of radical radiotherapy for primary tumors in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma

【摘要】目的初诊寡转移鼻咽癌患者原发灶根治性放疗预后因素分析。方法2008—2011年39例初诊寡转移鼻咽癌患者接受1～6周期化疗及原发灶根治性放疔．其中10例常规放疗．26例IMRT。Kaplan—Meier法计算生存率，Logrank单因素预后分析，Cox模型多因素预后分析。结果中位随访时间38个月，1、2、3年OS和PFS分别为97％及87％、87％及65％、70％及59％。年龄、转移灶数目、诱导化疗方案、是否同步化疗均是影响生存的因素，其中≤3个转移灶患者生存率更高（P=0．023），诱导化疗包含比不含多西他赛方案生存率明显提高（P=0．041）。结论初治寡转移鼻咽癌患者接受诱导化疗及原发灶根治性放疗后仍可获得长期生存，尤其是年龄小及转移灶数目≤3个患者。含多西紫杉醇的方案或能使患者得到更大生存获益。

Objective To investigate the prognostic factors for survival in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma who received radical radiotherapy for primary tumors. Methods From 2008 to 2011,39 patients with newly diagnosed oligometastatic nasopharyngeal carcinoma received 1-6 cycles of chemotherapy and radical radiotherapy for primary tumors. In those patients, 10 received conventional radiotherapy and 26 received intensity-modulated radiotherapy. The Kaplan-Meier method was used to calculate survival rates. The log-rank test and Cox model were used for univariate and multivariate prognostic analyses,respectively. Results The median follow-up time was 38 months. The 1-, 2-,and 3-year overall survival rates were 97%, 87%, and 70%, respectively, while the 1-, 2-, and 3-year progression-free survival rates were 87%, 65%, and 59%, respectively. Age, number of metastatic lesions, scheme of induction chemotherapy, and use of concurrent chemotherapy or not were independent prognostic factors for survival. The patients with no more than 3 metastatic lesions had a higher survival rate than those with more than 3 metastatic lesions （P = 0. 023 ）.The patients undergoing chemotherapy with docetaxel had a significantly higher survival rate than those undergoing chemotherapy without doeetaxel （P= 0. 041 ）. Conclusions Induction chemotherapy and radical radiotherapy for primary tumors can still achieve long- term survival in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma, particularly in young patients with no more than 3 metastatic lesions. Compared with chemotherapy without docetaxel, chemotherapy with docetaxel may provide a greater survival benefit for patients.