摘要/Abstract
摘要： 目的·评价调强放射治疗（intensity-modulated radiotherapy，IMRT）对局部复发鼻咽癌的疗效及不良反应，并进行相关预后分析。方法·将2012年1月—2016年8月共44例诊断为局部复发鼻咽癌且接受再程IMRT患者纳入研究，男33例，女11例，中位年龄51.5岁（25～76岁）。按照《美国癌症联合委员会癌症分期手册》2012版制定的分期标准，将患者划分为4组，其中rT1～rT4的患者分别占25.0%、22.7%、22.7%、29.6%。患者中位复发时间28个月（5～168个月），肿瘤靶区中位处方剂量66 Gy （54～70Gy）。参照美国肿瘤放射治疗协作组织分级标准评估不良反应。用Kaplan-Meier法计算生存率，用Log-rank检验和Cox回归模型进行生存预后相关因素的单因素和多因素分析。结果·再程IMRT结束3个月后完全缓解8例（18.2%）、部分缓解21例（47.7%）、稳定12例（27.3%）、进展3例（6.8%）。随访至2017年9月，全组患者3年生存率、3年总无进展生存率、3年局部无进展生存率和远处转移率分别为56.8%、43.2%、58.9%和11.4%。在单因素分析中，年龄、复发T分期、复发间隔、放射治疗前有/无合并明显并发症及对再程IMRT的反应为总生存率重要预后因素，其中复发T分期亦为无进展生存率的独立预后因素；在多因素分析中，复发T分期为总生存率、无进展生存率及局部无进展生存率的预后因素（均P<0.05）。随访期间死亡21例，5例死于大出血，有12例患者不同部位出现3～4级的不良反应。结论· IMRT为局部复发鼻咽癌有效的补救措施，可有效地提高生存率；但再程IMRT后部分患者出现严重不良反应。年龄较小、复发T分期较早及复发间隔较长是IMRT的良好预后因素。
关键词: 鼻咽癌, 复发, 调强放射治疗, 预后
Abstract:
Objective · To retrospectively analyze the treatment outcome, radiation toxicity and the prognostic factors in patients with locally recurrent nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Methods · January 2012 to August 2016, a total of44 patients who were diagnosed with locally recurrent NPC and received reirradiation with IMRT were included in the study. Among all the patients, there were 33 male patients and 11 female patients, the median age of whom was 51.5 years (range 25–76 years). According to the 2012 American Joint Committee on Cancer Stage Classification Cancer Staging Manual, the distribution of disease restaging was 25.0% for stage rT1, 22.7% for stage rT2,22.7% for stage rT3 and 29.6% for stage rT4. The median recurrence interval was 28 months (range 5–168 months). The median prescribed dose to the target volume was 66 Gy (range 54–70 Gy). The toxicities were evaluatedRadiation Therapy Oncology Group (RTOG). The survival rate was determined using the Kaplan-Meier method. Prognostic factors were analyzedLog-rank tests and Cox proportional hazard model. Results · Three months after reirradiation therapy, the complete remission rate, the partial remission rate, the stabilization rate and the progressive rate were 18.2%(8/44), 47.7% (21/44), 27.3% (12/44) and 6.8% (3/44), respectively. The 3-year overall survival (OS), 3-year progression free survival (PFS), 3-year local recurrence-free survival and distant metastasis rates were 56.8%, 43.2%, 58.9% and 11.4%, respectively. In a univariate analysis, age, recurrent T stage, recurrence interval, adverse reactions and response to re-IMRT were significant prognostic factors for OS and recurrent T stage was also an independent prognostic factor for PFS. In a multivariate analysis, recurrent T stage remained significant for OS and PFS. During follow-up, 21 patients died. Five patients died of nasopharynx hemorhea. Grade 3–4 toxicities were reported in 12 patients. Conclusion · Re-irradiation with IMRT is available to improve OS and thus is a reasonable choice for patients with locally recurrent NPC. However, the incidence of severe adverse events is still high. Younger ages lower recurrent T stage and longer recurrent interval are independent prognostic factors for OS of recurrent NPC.
Key words: nasopharyngeal carcinoma, recurrent, intensity-modulated radiotherapy, prognosis
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