鼻咽癌调强放射治疗后局部与区域复发模式
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摘要
目的探讨鼻咽癌患者接受调强放疗(intensity-modulated radiotherapy,IMRT)后的复发模式。方法回顾性分析2009年1月至2012年12月645例接受IMRT治疗、无远处转移的初治鼻咽癌患者的临床资料,Kaplan-Meier法计算生存率,并分析其复发模式,同时比较复发与未复发患者的剂量学差异。结果 645例患者中位随访62个月(11~95个月),其中复发(包括局部或区域复发)60例,单纯局部复发33例,区域复发23例,局部+区域复发4例。60例复发患者1年、3年、5年复发率分别为0.9%、6.5%、9.0%,总局部控制率分别为99.1%、93.4%、90.1%;野内复发56例,野边缘复发3例,野外复发1例;治疗结束后3年内49例患者复发。复发病例与未复发病例无剂量学差异。结论 IMRT治疗鼻咽癌局部控制率良好,复发最常见于治疗结束后3年内,男性多见,野内复发为局部与区域的主要复发模式。
Objective The aim of this study was to evaluate patterns of local or regional recurrence of nasopharyngeal carcinoma(NPC)in patients treated with intensity-modulated radiotherapy(IMRT). Methods We performed a retrospective analysis of 645 patients with NPC treated at three centers in China from January 2009 to December 2011. All patients had non-metastatic NPC that had not been treated prior to IMRT. The Kaplan-Meier method was used to calculate patient survival rates,and log-rank testing was used to compare survival differences,and explore treatment failure patterns for local or regional recurrence after radiotherapy. Results During a mean follow-up of 62 months(11-95),local recurrence rates were 0.9% at 1 year,6.5% at 3 years,and 9.0% at 5 years.Locoregional control rates were 99.1% at 1 year,93.4% at 3 years,and 90.1% at 5 years. In the 60 patients with recurrence,in-field recurrence rate was 93.3%(56/60);marginal-field recurrence,5.0%(3/60);and out-field recurrence,1.7%(1/60). Of all treatment failures,81.7%(49/60) occurred within the first three years after treatment. Conclusions IMRT resulted in excellent locoregional control in our NPC patients. Most cases of recurrence happened in the first three years after treatment. Locoregional failure most often involved in-field recurrence.
Objective The aim of this study was to evaluate patterns of local or regional recurrence of nasopharyngeal carcinoma(NPC)in patients treated with intensity-modulated radiotherapy(IMRT). Methods We performed a retrospective analysis of 645 patients with NPC treated at three centers in China from January 2009 to December 2011. All patients had non-metastatic NPC that had not been treated prior to IMRT. The Kaplan-Meier method was used to calculate patient survival rates,and log-rank testing was used to compare survival differences,and explore treatment failure patterns for local or regional recurrence after radiotherapy. Results During a mean follow-up of 62 months(11-95),local recurrence rates were 0.9% at 1 year,6.5% at 3 years,and 9.0% at 5 years.Locoregional control rates were 99.1% at 1 year,93.4% at 3 years,and 90.1% at 5 years. In the 60 patients with recurrence,in-field recurrence rate was 93.3%(56/60);marginal-field recurrence,5.0%(3/60);and out-field recurrence,1.7%(1/60). Of all treatment failures,81.7%(49/60) occurred within the first three years after treatment. Conclusions IMRT resulted in excellent locoregional control in our NPC patients. Most cases of recurrence happened in the first three years after treatment. Locoregional failure most often involved in-field recurrence.
引文
[1]Kang M,Zhou P,Long J,et al.A new staging system for nasopharyngeal carcinoma based on intensity-modulated radiation therapy(IMRT)[J].Oncotarget,2017,8(55):94188-94196.
[2]Zong J,Lin S,Lin J,et al.Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma:Validation of the 7th edition AJCC staging system[J].Oral Oncol,2015,51(3):254-259.
[3]Haberer-Guillerm S,Touboul E,Huguet F.Intensity modulated radiation therapy in nasopharyngeal carcinoma[J].Eur Ann Otorhino-laryngol Head Neck Dis,2015,132(3):147-151.
[4]Zhang B,Mo Z,Du W,et al.Intensity-modulated radiation therapy versus 2D-RT or 3D-CRT for the treatment of nasopharyngeal carcinoma:A systematic review and meta-analysis[J].Oral Oncol,2015,51(11):1041-1046.
[5]钟伟铭.复发性鼻咽癌三维适形放射治疗的疗效分析[J].中国癌症防治杂志,2009,1(2):151-152,158.
[6]Li Y,Qin Y,Yang C,et al.Cardamonin induces ROS-mediated G2/M phase arrest and apoptosis through inhibition of NF-kappa B pathway in nasopharyngeal carcinoma[J].Cell Death Dis,2017,8(8):e3024.
[7]Siti-Azrin AH,Norsaadah B,Naing NN.Prognostic factors of nasopharyngeal carcinoma patients in a tertiary referral hospital:a retrospective cohort study[J].BMC Res Notes,2017,10(1):705.
[8]林灿峰,李东升,林柏翰,等.鼻咽癌治疗后局部复发回顾性研究[J].中华肿瘤防治杂志,2017,24(3):188-191.
[9]中国鼻咽癌临床分期工作委员会.2010鼻咽癌调强放疗靶区及剂量设计指引专家共识[J].中华放射肿瘤学杂志,2011,20(4):267-269.
[10]Wang SY,Lou JL,Chen J,et al.Salvage surgery for neck residue or recurrence of nasopharyngeal carcinoma after primary radiotherapy:options of surgical methods and regions[J].World J Surg Oncol,2016,14:89.
[11]Zeng L,Guo P,Li J G,et al.Prognostic score models for survival of nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy and chemotherapy[J].Oncotarget,2015,6(36):39373-39383.
[12]邱素芳,陆嘉德,Ivanweng-Keongtham.复发期鼻咽癌的再程治疗:调强放射治疗技术的实施及展望[J].中国癌症杂志,2011,12(12):938-943.
[13]毛承刚,万俐佳,沈敏,等.鼻咽癌治疗后生存率和预后总结与分析[J].中国耳鼻咽喉颅底外科杂志,2015,21(5):386-389.
[14]李嘉欣,卢泰祥,黄莹,等.337例复发鼻咽癌患者的临床特征[J].癌症,2010,29(1):82-86.
[15]Ng WT,Lee MC,Hung WM,et al.Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2011,79(2):420-428.
[2]Zong J,Lin S,Lin J,et al.Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma:Validation of the 7th edition AJCC staging system[J].Oral Oncol,2015,51(3):254-259.
[3]Haberer-Guillerm S,Touboul E,Huguet F.Intensity modulated radiation therapy in nasopharyngeal carcinoma[J].Eur Ann Otorhino-laryngol Head Neck Dis,2015,132(3):147-151.
[4]Zhang B,Mo Z,Du W,et al.Intensity-modulated radiation therapy versus 2D-RT or 3D-CRT for the treatment of nasopharyngeal carcinoma:A systematic review and meta-analysis[J].Oral Oncol,2015,51(11):1041-1046.
[5]钟伟铭.复发性鼻咽癌三维适形放射治疗的疗效分析[J].中国癌症防治杂志,2009,1(2):151-152,158.
[6]Li Y,Qin Y,Yang C,et al.Cardamonin induces ROS-mediated G2/M phase arrest and apoptosis through inhibition of NF-kappa B pathway in nasopharyngeal carcinoma[J].Cell Death Dis,2017,8(8):e3024.
[7]Siti-Azrin AH,Norsaadah B,Naing NN.Prognostic factors of nasopharyngeal carcinoma patients in a tertiary referral hospital:a retrospective cohort study[J].BMC Res Notes,2017,10(1):705.
[8]林灿峰,李东升,林柏翰,等.鼻咽癌治疗后局部复发回顾性研究[J].中华肿瘤防治杂志,2017,24(3):188-191.
[9]中国鼻咽癌临床分期工作委员会.2010鼻咽癌调强放疗靶区及剂量设计指引专家共识[J].中华放射肿瘤学杂志,2011,20(4):267-269.
[10]Wang SY,Lou JL,Chen J,et al.Salvage surgery for neck residue or recurrence of nasopharyngeal carcinoma after primary radiotherapy:options of surgical methods and regions[J].World J Surg Oncol,2016,14:89.
[11]Zeng L,Guo P,Li J G,et al.Prognostic score models for survival of nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy and chemotherapy[J].Oncotarget,2015,6(36):39373-39383.
[12]邱素芳,陆嘉德,Ivanweng-Keongtham.复发期鼻咽癌的再程治疗:调强放射治疗技术的实施及展望[J].中国癌症杂志,2011,12(12):938-943.
[13]毛承刚,万俐佳,沈敏,等.鼻咽癌治疗后生存率和预后总结与分析[J].中国耳鼻咽喉颅底外科杂志,2015,21(5):386-389.
[14]李嘉欣,卢泰祥,黄莹,等.337例复发鼻咽癌患者的临床特征[J].癌症,2010,29(1):82-86.
[15]Ng WT,Lee MC,Hung WM,et al.Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2011,79(2):420-428.