454例鼻咽癌IMRT±化疗远期疗效及影响因素分析

目的 对454例鼻咽癌IMRT±化疗的远期疗效及影响因素分析。方法 回顾分析本中心2007—2012年采用IMRT±化疗的454例无远处转移鼻咽癌患者资料。放疗处方剂量:鼻咽大体肿瘤69.96~73.92 Gy分33次, 颈部转移淋巴结69.96 Gy分33次, 高危引流区60.06 Gy分33次, 低危引流区50.96 Gy分28次。诱导化疗438例, 同期化疗420例, 辅助化疗216例, 顺铂、紫杉醇为主。Kaplan-Meier法计算生存并Logrank 法检验和单因素预后分析, Cox法多因素预后分析。结果 3年样本数为210例, 3年OS、LRFS、NRFS、PFS、DMFS分别为88.1%、91.0%、90.7%、80.5%、85.1%。影响OS因素有年龄(P=0.011)、T分期(P=0.005)、N分期(P=0.033);T、N分期对DPFS (P=0.017、 0.005)、DMFS (P=0.012、0.019)均有影响。≥3级急性及晚期不良反应主要为血液学、口腔黏膜反应, 口干、吞咽困难和脑损伤。结论 IMRT提高了鼻咽癌患者长期生存, 远处转移是主要失败原因, IMRT联合化疗不良反应能耐受。

Long-term efficacy of intensity-modulated radiotherapy with or without chemotherapy in treatment of nasopharyngeal carcinoma and its influencing factors:an analysis of 454 patients

Objective To analyze the long-term efficacy of intensity-modulated radiotherapy (IMRT) with or without chemotherapy in treatment of 454 patients with nasopharyngeal carcinoma (NPC) and its influencing factors. Methods A retrospective analysis was performed on the clinical data of 454 patients with non-metastatic NPC who received IMRT with or without chemotherapy in our center from 2007 to 2012. Prescribed doses of 69.96-73.92 Gy in 33 fractions, 69.96 Gy in 33 fractions, 60.06 Gy in 33 fractions, and 50.96 Gy in 28 fractions were applied to nasopharyngeal gross tumor volume, cervical metastatic lymph nodes, high-risk drainage area, and low-risk drainage area, respectively. In all patients, 438 received induction chemotherapy, 420 concurrent chemotherapy, and 216 adjuvant chemotherapy, most of which were based on cisplatin and taxol. The Kaplan-Meier method was used for calculating survival rates and the log-rank test was used for survival difference analysis and univariate prognostic analysis. The Cox model was used for the multivariate prognostic analysis. Results The 3-year sample size was 210. The 3-year overall survival (OS), local recurrence-free survival, nodal relapse-free survival, progression-free survival, and distant metastasis-free survival (DMFS) rates were 88.1%, 91.0%, 90.7%, 80.5%, and 85.1%, respectively. Age, T stage, and N stage were influencing factors for the OS rate (P=0.011;P=0.005;P=0.033);T stage and N stage were influencing factors for the disease progression-free survival (P=0.017;P=0.005) and DMFS (P=0.012;P=0.019). The grade ≥3 acute and late adverse reactionsincluded hematological toxicity, oral mucositis, xerostomia, dysphagia, and brain injury. Conclusions
IMRT promotes the long-term survival rates in patients with NPC. The distant metastasis is the major reason for treatment failure. The adverse reactions induced by IMRT combined with chemotherapy are tolerable.