132例鼻咽癌调强放疗长期生存及晚期损伤分析

Analysis of long-term survival outcomes and late radiation toxicity of 132 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy

目的回顾性分析鼻咽癌调强放疗(IMRT)后长期生存及晚期损伤,为鼻咽癌优化治疗提供参考。方法纳入2003—2009年间于四川省肿瘤医院行IMRT的132例初治鼻咽癌患者,其中Ⅰ、Ⅱ、Ⅲ、ⅣA、ⅣB期分别为3、22、61、43、3例。中位剂量73.37Gy(66~85Gy)分33次;单纯放疗20例,同期放化疗112例。采用Kaplan-Meier法计算生存率,log-rank法检验及单因素预后分析,Cox模型多因素预后分析。应用RTOG/EORTC标准评价晚期放射损伤。结果中位随访时间128个月(3~191个月),全组10、15年鼻咽癌局控率分别为86.0%、79.9%,无瘤生存率分别为72.5%、63.2%,总生存(OS)率分别为65.2%、57.1%。全组局部区域复发率12.1%,远处转移率16.7%。共53例死亡,其中15例死于局部区域复发、20例死于远处转移、18例死于其他疾病(肺炎、颅内出血、意外等);10、15年非肿瘤相关死亡率分别为11.3%、13.6%。单因素分析示年龄、吸烟史、乳酸脱氢酶、T分期、临床分期是鼻咽癌OS的独立预后因素;多因素分析示乳酸脱氢酶、T分期、同期放化疗是鼻咽癌OS的预后因子。1-2级晚期损伤(听力下降、吞咽困难、龋齿、口干较高)发生率为90.4%,3-4级晚期损伤(皮肤纤维化、听力下降、放射性脑损伤)发生率8.5%。结论鼻咽癌患者IMRT后10、15年OS较好,但随着生存期延长非肿瘤相关死亡率升高;远处转移为治疗失败的主要原因;晚期损伤主要为1-2级听力下降、吞咽困难、龋齿、口干。

Objective To retrospectively analyze the long-term survival(10-15 years)and late toxicity of nasopharyngeal carcinoma(NPC)patients after intensity-modulated radiotherapy(IMRT),aiming to provide reference for the optimal treatment of NPC.Methods 132 patients with NPC who were treated with IMRT in Sichuan Cancer Hospital from 2003 to 2009 were recruited.Among them,3 patients were classified as stageⅠ,22 cases of gradeⅡ,61 cases of gradeⅢ,43 cases ofⅣA and 3 cases ofⅣB,respectively.The median dose was 73.37Gy(66 to 85Gy),divided into 33 times.Twenty patients received radiotherapy alone,112 cases of concurrent radiochemotherapy.The survival rate was calculated by Kaplan-Meier method and log-rank test.Univariate prognostic analysis was performed.Cox model was used to conduct multivariate prognostic analysis.The late radiation toxicity was evaluated by RTOG/EORTC criteria.Results The median follow-up duration was 128 months(range,3 to 191 months).The 10-and 15-year local control rates of NPC patients were 86.0%and 79.9%.The disease-free survival rates were 72.5%and 63.2%,and the overall survival(OS)rates were 65.2%and 57.1%.The local recurrence rate was 12.1%,and the distant metastasis rate was 16.7%.A total of 53 patients died,of whom 15 patients died of local recurrence,20 patients died of distant metastasis and 18 patients died of other diseases(pneumonia,intracranial hemorrhage and accident,etc.).The 10-and 15-year non-tumor-related mortality rates were 11.3%and 13.6%.Univariate analysis showed that age,smoking habit,lactate dehydrogenase(LDH),T stage and clinical stage were the independent prognostic factors of OS in NPC patients.Multivariate analysis demonstrated that LDH,T stage and synchronous chemotherapy were the prognostic factors of OS in NPC patients.The incidence of gradeⅠ-Ⅱlate radiation injury(hearing impairment,dysphagia,dental caries and xerostomia)was 90.4%,and 8.5%for gradeⅢ-Ⅳlate radiation injury(skin fibrosis,hearing impairment and radiation brain injury).Conclusions The 10-and 15-year OS of NPC patients treated with IMRT is relatively high.With the prolongation of survival,the non-tumor-related mortality rate is increased.Distant metastasis is the main cause of treatment failure.The main late injuries include gradeⅠ/Ⅱhearing impairment,dysphagia,dental caries and xerostomia.