碳离子调强放射治疗复发性局部晚期鼻咽癌的近期疗效及不良反应

目的 分析局部复发性鼻咽癌患者再程调强碳离子放射治疗（IMCT）和调强X射线放射治疗（IMXT）后的近期疗效及不良反应。方法 收集本院2015年5月至9月收治的14例确诊为局部复发性鼻咽癌的患者，经再程IMCT治疗后，观察其治疗相关不良反应及近期疗效，并与2012年5月至2014年5月接受再程IMXT挽救性治疗的47例患者进行比较分析。复发肿瘤体积的IMCT和IMXT的处方剂量分别为50～60 GyE（2.0～2.5 GyE/次）和54～66 Gy/27～33次（2.0～2.1 Gy/次）。结果 两组患者在性别、年龄、初诊分期、初诊治疗策略、复发距首次IMXT时间间隔、复发T、N分期差异均无统计学意义（P>0.05）。两组患者放疗后3个月的完全缓解率（64.3%和78.7%）差异无统计学意义（P>0.05），且在6个月内均无局部肿瘤进展，但IMXT组有2例死亡，其中1例死于鼻咽坏死大出血。IMCT组治疗中的急性中重度黏膜炎的发生率为0，明显低于IMXT组的31.9%（P<0.05）。IMXT治疗后6个月内黏膜坏死的发生率为29.8%，明显高于IMCT组的0（P<0.05）；IMXT组有2例（4.3%）伴症状的颞叶坏死，IMCT组无颞叶坏死；两组均无颅神经损伤发生。结论 同再程IMXT挽救治疗相比，复发性局部晚期鼻咽癌再程IMCT后近期疗效类似，且未出现2级或以上的近期不良反应，但IMCT的远期疗效尚需更长时间的观察。

Early results of carbon-ion radiation therapy in the treatment of locally recurrent nasopharyngeal carcinoma

Objective To compare the short-term outcomes with regards to efficacy and toxicity after reirradiation using intensity-modulated carbon-ion radiotherapy (IMCT) or intensity-modulated radiation therapy (re-IMXT) in nasopharyngeal cancer (NPC) patients who developed local recurrence (LRNPC) after their initial, definitive IMXT course. Methods The short-term outcomes of 14 patients retreated for LRNPC between May of 2015 and September of 2015, who were followed-up for at least 3 months after salvage IMCT, were compared to those of 47 similar patients retreated with repeat IMXT between 2012 and 2014. Dose of salvage IMCT and re-IMXT were 50-60 GyE (2.0-2.5 GyE/d) and 54-66 Gy (2.0-2.1 Gy/d), respectively. Results The characteristics of the patients and disease including:patients'' gender, age, stage at initial diagnosis, time interval between the initial IMXT and local recurrence, dose of initial IMXT, and the use of chemotherapy during initial treatment, and N-classification at recurrence were similar between the 2 groups. Complete response rates at 3-month follow-up were 64.3% vs. 78.7% between the salvaging IMCT and re-IMXT groups, respectively (P0.05). No patients developed local disease progression in either group within 6-month follow-up, but 2 patients died after re-IMXT including 1 from massive nasopharyngeal hemorrhage.The probability of acute mucositis (31.9% vs. 0, P<0.05) and mucosal necrosis/hemorrhage (29.8% vs. 0, P<0.05) were significantly higher in patients who received re-IMXT as compared to those who received salvage IMCT. In addition, 2 patients developed symptomatic temporal lobe necrosis after re-IMXT, while none developed this in the IMCT group. No patients developed cranial nerve palsy.Conclusions When locally recurrent NPC after primary definitive IMXT is retreated with either IMCT or IMXT, similar response rates and overall survival times within 6 months after re-irradiation are observed. However, no patient who received salvage IMCT developed acute or subacute toxicities of grade 2 or above, whereas 29.8% patients experienced life-threatening mucosal necrosis/hemorrhage after re-IMXT. The long-term outcome of salvage IMCT in LRNPC needs further follow-up.