Long-term survival of nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy

Purpose: The purpose of this study is to demonstrate long-term survival of nasopharyngeal carcinoma treated with concomitant chemotherapy and radiotherapy (CCRT) followed by adjuvant chemotherapy.

Methods and Patients: One hundred and seven patients with Stage III and IV (American Joint Committee on Cancer, AJCC, 1988) nasopharyngeal carcinoma (NPC) were treated with concomitant chemotherapy and radiotherapy (CCRT) followed by adjuvant chemotherapy between April 1990 and December 1997 in Koo Foundation Sun Yat-Sen Cancer Center, Taipei. The dose of radiation was 70 Gray (Gy) given in 35 fractions, 5 fractions per week. Two courses of chemotherapy, consisting of cisplatin and 5-fluorouracil, were delivered simultaneously with radiotherapy in Weeks 1 and 6 and two additional monthly courses were given after radiotherapy. According to the AJCC 1997 staging system, 32 patients had Stage II disease, 44 had Stage III, and 31 had Stage IV disease.

Results: With median follow-up of 44 months, the 5-year overall survival rate in all 107 patients was 84.1%, disease-free survival rate was 74.4%, and locoregional control rate was 89.8%. The 3-year overall survival for Stage II was 100%, for Stage III it was 92.8%, and for Stage IV, 69.4% (p = 0.0002). The 3-year disease-free survival for Stage II was 96.9%, for Stage III it was 87.7%, and for Stage IV it was 51.9% (p = 0.0001).

Conclusion: CCRT and adjuvant chemotherapy is effective in Taiwanese patients with advanced NPC. The prognosis of AJCC 1997 Stage II and III disease is excellent, but, for Stage IV (M0), it is relatively poor. Future strategies of therapy should focus on high-risk AJCC 1997 Stage IV (M0) cohort.     

Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

Background:The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma (NPC) in the intensity?modulated radiotherapy (IMRT) era. Methods:We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center (South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging (MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniifcant explanatory variables. Results:The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiifcant prognostic fac?tor for local failure (P=0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho’s location of the cervical lymph nodes were signiifcant prognostic factors for both distant failure and disease failure (allP<0.05). Intracranial extension had signiifcant prognostic value for distant failure (P=0.040). Conclusions:The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiifcant prognostic parameters for local control have also been altered substantially.     

Accelerated concomitant boost radiotherapy and chemotherapy for advanced nasopharyngeal carcinoma.

PURPOSE: To evaluate the feasibility and efficacy of concomitant boost radiotherapy (RT) plus cisplatin-based chemotherapy compared with standard fractionation RT for patients with advanced nasopharyngeal cancer. PATIENTS AND METHODS: From 1988 through 1999, 50 patients with American Joint Committee on Cancer stage II-IVb nasopharyngeal carcinoma were treated with 70-Gy concomitant boost RT (1.8 Gy/d, weeks 1 through 6; 1.6 Gy second daily fraction, weeks 5 through 6) and two cycles of concurrent cisplatin 100 mg/m(2) days 1 and 22. Thirty-seven patients also received three cycles of cisplatin-based adjuvant chemotherapy. These 50 patients were compared with a nonrandomized cohort of 51 patients with nasopharyngeal cancer treated with 70-Gy standard fractionation RT (1.8 Gy/d) without chemotherapy from 1988 through 1995. The groups were well matched for prognostic factors except stage, for which the concomitant boost RT/chemotherapy group was more advanced (54%, T3-4; 54%, N2-3; 44%, stage IV) compared with the standard RT group (31%, T3-4, P =.03; 22%, N2-3, P <.001; 20%, stage IV, P <.01). RESULTS: With a median follow-up of 42 months (range, 12 to 129 months), the 3-year actuarial local control, progression-free survival, and survival rates were 89% v 74% (P <.01), 66% v 54% (P =.01), and 84% v 71% (P =.04) for the concomitant boost RT/chemotherapy group and the standard RT patients, respectively. Acute grade 3 mucositis was more prevalent with combined therapy, 84% v 43% (P <.001), resulting in a higher rate of temporary gastrostomy tube placement, 46% v 20% (P <.01). CONCLUSION: Concomitant boost RT with cisplatin-based chemotherapy is feasible and improves local-regional control as well as survival for patients with advanced nasopharyngeal cancer compared with standard RT alone.     

TPF方案诱导化疗加同期调强放化疗治疗晚期鼻咽癌的临床观察

目的:探讨TPF方案诱导化疗结合同期调强放化疗治疗局部区域晚期鼻咽癌的有效剂量及近期疗效.方法:Docetaxel与DDP剂量60 mg/m2,静脉滴入;5-FU初始剂量450 mg/(m2·d),持续120 h静脉灌注,按50 mg/(m2·d)剂量递增,根据剂量递增法则确定其最大耐受剂量(MTD),观察终点为出现剂量限制性毒性(DLT).每位患者行3个周期诱导化疗,每个周期化疗间隔3周,第3个周期化疗后3周给予调强放疗(IMRT)加上同期DDP 80 mg/m2化疗.结果:12例患者共完成了450～550 mg/(m2·d)3个剂量水平共34个周期诱导化疗.在550 mg/(m2·d)剂量水平,1例患者出现3度黏膜反应及4度腹泻的DLT,按既定方案再以此剂量依次治疗3例患者,未再发生DLT,该剂量水平即为MTD.除1例DLT患者停止诱导化疗外,余11例患者均行3个周期诱导化疗,3个周期诱导化疗后总反应率(OR)100%,完全缓解率(CR)64%(7/11).12例患者均完成同期放化疗,诱导化疗未加重同期放化疗的毒副反应.结论:TPF方案在Docetaxel 60 mg/m2、DDP 60 mg/m2剂量前提下治疗局部区域晚期鼻咽癌,5-FU的 MTD为550 mg/(m2·d),该方案具有较高近期反应率.     

Outcomes and prognostic factors of conformal radiotherapy versus intensity-modulated radiotherapy for nasopharyngeal carcinoma

Introduction

This study retrospectively compared outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) treated with conformal radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT).

Materials and methods

The treatment records of 182 patients treated with IMRT and 198 patients treated with CRT from April 2005 to December 2007 in our hospital were reviewed. The clinical characteristics, treatment outcomes (including survival analysis and acute and late toxicity), and prognostic factors of the two groups were compared.

Results

The 4-year local?Cregional control (LRC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) of the IMRT and CRT groups were 93.6 and 85.3?%, 79.1 and 73.6?%, 74.7 and 65.0?%, and 83.5 and 72.1?%, respectively. The acute radiation dermatitis and xerostomia of the two groups were significantly different (P?<?0.05). In the IMRT group, OS between different T stages could not be well separated. Multivariate analysis revealed that, in the CRT group, the clinical stage and T and N stages were significant prognostic factors for OS, DMFS, and DFS and that T stage was a significant prognostic factor for LRC. In the IMRT group, T and N stages had no predictive value for outcomes.

Conclusions

Compared with CRT, IMRT has a better prognosis and less adverse effects. For IMRT, T stage was not a significant prognostic factor for LRC, DMFS, DFS, or OS. An effective treatment strategy is needed for distant control. With the increasing use of IMRT and continued modulation of treatment strategies for NPC, the current staging system faces great challenges.     

食管癌术后同步放化疗的临床研究

目的：探讨术后辅助放化疗对食管癌患者生存期的影响,并分析其预后因素。方法：２００２年４月～２００４年６月,选择经根治术后病理学检查确诊的食管鳞癌患者９０例,分成３组,每组３０例,治疗组采用放化疗同步治疗,另设单纯放疗组和单纯化疗组作为对照组进行研究。单纯放疗组于术后３～６周内开始用１５ＭＶ-Ｘ线照射,ＤＴ５０Ｇｙ／２５ｆ,３０天完成。单纯化疗组于术后３～４周内开始用ＦＰ方案化疗,治疗组放化疗的剂量同对照组。结果：全部患者的１年、３年、５年生存率及中位生存期分别为９０.０％、４３.３％和３７.２５％及３２个月,３组比较生存时间无明显差异。单因素分析提示临床分期、有无淋巴结转移及病变局部有无溃疡是影响生存的主要因素,多因素分析提示有无淋巴结转移及病变局部有无溃疡是其预后的独立因素。结论：食管癌术后应用单纯放疗、化疗或同步放化疗作为辅助治疗手段疗效上似无明显差异,有无淋巴结转移和病变局部有无溃疡为其独立预后因素。     

Stereotactic radiosurgical boost following radiotherapy in primary nasopharyngeal carcinoma: impact on local control

PURPOSE: Treatment of patients with nasopharyngeal carcinoma using external beam radiation therapy (EBRT) alone results in significant local recurrence. Although intracavitary brachytherapy can be used as a component of management, it may be inadequate if there is extension of disease to the skull base. To improve local control, stereotactic radiosurgery was used to boost the primary tumor site following fractionated radiotherapy in patients with nasopharyngeal carcinoma. METHODS AND MATERIALS: Twenty-three consecutive patients were treated with radiosurgery following radiotherapy for nasopharyngeal carcinoma from 10/92 to 5/98. All patients had biopsy confirmation of disease prior to radiation therapy; Stage III disease (1 patient), Stage IV disease (22 patients). Fifteen patients received cisplatinum-based chemotherapy in addition to radiotherapy. Radiosurgery was delivered using a frame-based LINAC as a boost (range 7 to 15 Gy, median 12 Gy) following fractionated radiation therapy (range 64.8 to 70 Gy, median 66 Gy). RESULTS: All 23 patients (100%) receiving radiosurgery as a boost following fractionated radiation therapy are locally controlled at a mean follow-up of 21 months (range 2 to 64 months). There have been no complications of treatment caused by radiosurgery. However, eight patients (35%) have subsequently developed regional or distant metastases. CONCLUSIONS: Stereotactic radiosurgical boost following fractionated EBRT provides excellent local control in advanced stage nasopharynx cancer and should be considered for all patients with this disease. The treatment is safe and effective and may be combined with cisplatinum-based chemotherapy.     

同期放化疗联合辅助化疗治疗局部晚期鼻咽癌的前瞻性临床研究

 目的　探讨同期放化疗联合辅助化疗对鼻咽癌高发区人群的疗效及不良反应情况。方法　2006年1月至2010年6月入组141例鼻咽癌患者,随机数字表法分为同期放化疗联合辅助化疗组（70例）和同期放化疗组（71例）。两组均采用二维精确放射治疗和2个疗程顺铂、5-氟尿嘧啶（5-Fu）同步化疗;同期放化疗联合辅助化疗组在放疗结束后3周开始3个疗程顺铂、5-Fu辅助化疗。结果　所有入组患者均按计划完成同期放化疗,同期放化疗联合辅助化疗组有63例完成辅助化疗。两组同步放化疗期和同期放化疗联合辅助化疗组辅助化疗期主要不良反应有黏膜炎、白细胞减少、血小板减少和胃肠道反应,两组比较差异无统计学意义。放疗结束后3个月,同期放化疗联合辅助化疗组和同期放化疗组鼻咽部、颈部淋巴结肿瘤消退率分别为94.4 %（67／70）和87.3 %（62／71）。中位随访36个月。同期放化疗联合辅助化疗组1、2、3年总生存率分别为94.3 %、84.8 %、78.6 %,中位生存期为36个月,同期放化疗组分别为90.1 %、75.0 %、62.5 %,中位生存期为27个月,两组比较差异有统计学意义（χ2＝7.356 ,P＝0.007）。同期放化疗联合辅助化疗组Ⅲ期患者1、2、3年总生存率分别为98.2 %、92.5 %、83.7 %,同期放化疗组分别为93.0 %、83.2 %、68.2 %,中位生存时间均为36个月;两组比较差异有统计学意义（χ2＝8.081, P＝0.005）。同期放化疗联合辅助化疗组Ⅳ期患者1、2、3年总生存率分别为81.3 %、53.8 %、42.9 %,同期放化疗组分别为78.6 %、36.4 %、22.3 %,中位生存时间分别为22个月和14个月,两组比较差异有统计学意义（χ2＝3.903,P＝0.048）。同期放化疗联合辅助化疗组1、2、3年无进展生存率分别为90.0 %、76.2 %、68.8 %,同期放化疗组分别为81.7 %、60.3 %、34.3 %,中位无进展生存时间分别为30个月和22个月,两组比较差异有统计学意义（χ2＝13.616,P＝0.000）。结论　对鼻咽癌高发区Ⅲ、Ⅳ期鼻咽癌患者,该同期放化疗联合辅助化疗方案依从性较高,不良反应相对较低,可提高总生存率及无进展生存率。     

582例鼻咽癌调强放疗5年远期疗效及预后分析

目的 评价本院鼻咽癌调强放疗(IMRT)的远期疗效和预后因素。方法 回顾分析2001 -2004年进行IMRT的582例初治鼻咽癌患者的临床结果,其中Ⅰ、Ⅱ、Ⅲ、Ⅳa期分别为36、144、224、178例。所有患者鼻咽和上颈部靶区均采用NOMOS的IMRT技术。运用美国放疗肿瘤组织标准评价急慢性不良反应,Kaplan-Meier法进行生存率分析,多因素预后分析采用Cox回归模型。结果 随访率为93.5％。5年局部控制率、区域控制率、无远处转移生存率、无瘤生存率、疾病特异生存率和总生存率分别为89.8％、95.2％、74.1％、69.6％、83.2％和77.1％。局部复发29例,区域复发13例,远处转移117例。3级急性和慢性不良反应分别为44.5％(唾液腺、口腔黏膜和皮肤)和4.2％。多因素分析表明影响总生存率的独立预后因素为临床分期、N分期、放疗中断时间、治疗前血红蛋白含量、体重降低幅度和化疗。结论 IMRT鼻咽癌获得了较好的远期疗效和生存质量;临床分期和N分期是影响总生存率的预后因素;远处转移是治疗失败的主要因素;急慢性不良反应主要为1～2级。     

A prognostic scoring system for locoregional control in nasopharyngeal carcinoma following conformal radiotherapy

Purpose: This study established a prognostic scoring system for nasopharyngeal carcinoma (NPC), which estimates the probability of locoregional (LR) control following definitive conformal radiotherapy. METHODS AND MATERIALS: Patients with nondisseminated NPC at initial presentation (n = 630) were enrolled in this study. All patients had magnetic resonance imaging of the head and neck and were treated with conformal radiotherapy. Among them, 93% had concurrent chemotherapy, and 76% had postradiation chemotherapy. The extent of the primary tumor, age at diagnosis, primary tumor size, tumor and nodal classification, histology, and serum lactate dehydrogenase (LDH) level before treatment were included in the analysis for building a prognostic scoring system. The end point for this study was LR control. RESULTS: The prognostic score was defined as the number of adverse prognostic factors present at diagnosis. Four factors had similarly independent prognostic effects (hazard ratio, 2.0-2.6): age >40 years, histologic WHO type I-II, serum LDH level > or =410 U/L, and involvement of two or more sites of the following anatomic structures, i.e., sphenoid floor, clivus marrow, clivus cortex, prevertebral muscles, and petrous bone. The score predicted the 5-year probability of LR control as follows: 0 (15% of the patients), 100%; 1 (42% of the patients), 93%; 2 (29% of the patients), 83%; 3 or higher (13% of the patients), 71%. CONCLUSION: This scoring system is useful in the decision-making for individual patients and the design of clinical trials to improve LR control for advanced-stage NPC.     

早期鼻咽癌66例放射治疗结果和预后因素分析

目的　分析早期鼻咽癌治疗结果和预后影响因素。方法　采用 Ｋａｐｌａｎ Ｍｅｉｅｒ 及 Ｃｏｘ 回归方法回顾性分析接受放射治疗的早期鼻咽癌６６ 例。结果　全组５ 年无瘤生存率、局部控制率、远地转移率分别为７１ ．６ ％ ,８７ ．８ ％ 和１７ ．４ ％ 。鼻咽肿物放射治疗 Ｄ Ｔ ＜ ４０ Ｇｙ 消退者在生存率和远地转移的控制上均差于 Ｄ Ｔ ＞ ４０ Ｇｙ 消退者,二者差异有显著性（ Ｐ＜ ０ ．０５） ;在局部控制率上,二者差异无显著性;外周血血红蛋白低于１１０ ｇ／ Ｌ 者无瘤生存率、局部控制率均差于血红蛋白＞ １１０ ｇ／ Ｌ 者,且差异有显著性（ Ｐ＜ ０ ．０５） ;而二者远地转移率差异无显著性（ Ｐ＞ ０ ．０５） 。结论　鼻咽肿物对射线越敏感越容易发生远地转移,生存率越差;血红蛋白水平越低,局部控制率和生存率越差。     

鼻咽癌调强放疗长期疗效及预后分析

目的 评估鼻咽癌调强放疗的长期疗效,分析影响预后的因素。方法 回顾分析 299例无远处转移鼻咽癌首程治疗病例资料。鼻咽原发灶及上颈部调强放疗70 Gy,下颈部及锁骨上区用单前野预防性常规放疗54 Gy,5 次/周共30次。鼻咽残存灶采用局部小野IMRT加量或X刀补充照射 4~20 Gy。用Kaplan-Meier方法计算总生存率(OS)、无疾病进展生存率(DPFS)、无远处转移生存率(DMFS)等,Logrank法检验和单因素预后分析,Cox法多因素预后分析。结果 全组随访率为99.7%,随访时间满 5年者为 119例。Ⅰ+Ⅱ、Ⅲ、Ⅳ期 5年OS分别为97.1%、82.7%、52.2%(χ²=46.19,P=0.000),DPFS分别为100%、77.6%、57.7%(χ²=23.29,P=0.000),DMFS分别为100%、82.3%、63.7%(χ²=16.57,P=0.000)。男性和女性 5年OS、DPFS、DMFS分别为70.7%和94.1%(χ²=16.82,P=0.000)、71.5%和87.3%(χ²=4.74,P=0.029)、77.2%和89.7%(χ²=4.38,P=0.036);<45岁男性和女性的分别为66.8%和91.2%(χ²=7.07,P=0.008)、59.9%和91.2%(χ²=7.72,P=0.005)、66.4%和94.0%(χ²=8.46,P=0.004),≥45岁的只有OS不同(72.2%和96.0%,χ²=10.19,P=0.001)。多因素分析显示性别、TNM分期、淋巴结包膜受侵均影响OS (χ²=14.27、5.72、17.64,P=0.000、0.017、0.000)、DPFS (χ²=5.33、15.70、10.57,P=0.021、0.000、0.001)、DMFS (χ²=4.30、11.08、21.24,P=0.038、0.001、0.000),颅内受侵、锁骨上淋巴结转移影响OS (χ²=13.32、5.38,P=0.000、0.020)。结论 除分期、淋巴结包膜受侵影响预后外,性别也是影响预后因素之一,特别是<45岁男性预后更差。     

不同年龄组鼻咽癌放射治疗的远期疗效及影响因素

目的:分析1706例不同年龄组鼻咽癌放射治疗的远期疗效,并探讨影响其疗效的有关因素。方法:回顾性分析1995年～1998年经病理证实在我院接受根治性放疗的鼻咽癌患者1706例,按其不同年龄段分为三组:A组(≤30岁)156例,B组(31～60岁)1326例,C组(>60岁)224例,对不同年龄组的生存率进行比较,并对年龄、性别、T、N分期等因素作多因素分析。结果:A、B、C三组患者的1、3、5年生存率分别为96.80%、84.32%、77.93%;94.54%、80.85%、69.56%和89.77%、67.23%、50.64%。通过生存曲线统计分析得出三组患者总生存时间的差别有统计学意义(χ2=62.94,P=0.000)。Cox回归分析结果显示,影响鼻咽癌远期疗效的独立因素有年龄、性别、92福州分期、T分期、N分期、是否化疗、治疗中断与否,而与放疗剂量、放疗方式无关。结论:年龄是影响鼻咽癌长期生存的独立预后因素之一,年龄越小,预后越好。     

Temporal lobe injury after re-irradiation of locally recurrent nasopharyngeal carcinoma using intensity modulated radiotherapy: clinical characteristics and prognostic factors

Temporal lobe injury (TLI) is a debilitating complication after radiotherapy for nasopharyngeal carcinoma (NPC), especially in patients who suffer treatment relapses and receive re-irradiation. We explored the clinical characteristics and prognostic factors of TLI in locally recurrent NPC (rNPC) patients after re-irradiation using intensity modulated radiotherapy (IMRT). A total of 454 temporal lobes (TLs) from 227 locally rNPC patients were reviewed. The clinical characteristics of TLI were analyzed. In the two radiotherapy courses, the equivalent dose in 2 Gy per fraction (EQD2) for the TLs was recalculated to facilitate comparison of the individual data. The median follow-up time was 31 (range, 3–127) months. After re-irradiation using IMRT, 31.3 % (71/227) of patients developed TLI. The median latency of TLI was 15 (range, 4–100) months. Univariate and multivariate analysis showed that the interval time (IT) between the two courses of radiotherapy and the summation of the maximum doses of the two radiotherapy courses (EQD2 ? ∑_max) were independent factors influencing TLI. The 5-year incidence of TLI for an IT ≤26 or >26 months was 35.9 and 53.7 % respectively (p = 0.024). The median maximum doses delivered to the injured TLs were significantly higher than was the case for the uninjured TLs after two courses of radiotherapy (135.3 and 129.8 Gy, respectively: p < 0.001). The incidence of TLI with an EQD2 ? ∑_max < 125 Gy was <5 %, and with an EQD2 ? ∑_max <145 Gy it was <50 %. A treatment mode limiting EQD2 ? ∑_max <125 Gy with a >2-year interval was found to be relatively safe.     

鼻咽癌放射治疗的历史和现状及未来的方向

鼻咽癌具有明显的地区聚集性,我国南方的广东省是全世界最为高发的地区,其世界人口标化发病率高达男性30/10万,女性13/10万.与其它头颈恶性肿瘤不同,大多数鼻咽癌分化程度较差,恶性程度较高,有向周围组织浸润性生长的特性,极易发生淋巴管转移;而鼻咽部又深居头颅中央,毗邻许多重要的血管、神经组织,手术暴露受到限制,更不可能作肿瘤和淋巴引流区的大范围切除手术;此外,鼻咽癌对射线有较高的敏感性,一定的照射剂量可使肿瘤局部获得较好的控制.     

Prognostic features and treatment outcome in locoregionally advanced nasopharyngeal carcinoma following concurrent chemotherapy and radiotherapy

Purpose: Concurrent chemotherapy and radiotherapy (CCRT) are effective in treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). However, the prognostic factors after CCRT have not been evaluated. We therefore attempt to evaluate factors that influence treatment outcomes following CCRT.Methods and Materials: Seventy-four (5 in stage III and 69 in stage IV) patients with locoregionally advanced NPC were treated with CCRT. Radiotherapy was delivered either at 2 Gray (Gy) per fraction per day up to 70 Gy or 1.2 Gy, 2 fractions per day, up to 74.4 Gy. Concurrent chemotherapy consisted of cisplatin and 5-fluorouracil. Cox proportional-hazards model was used to analyze the prognostic factors which included age, gender, pathologic type, T, N, lactate dehydrogenase (LDH), and infiltration of the clivus.Results: The primary tumor control rate at 3 years was 96.7% (95% confidence interval [CI]: 92.5–100), distant metastasis–free survival 81.1% (95% CI: 70.6–91.6), disease-free survival 77.0% (95% CI: 65.3–88.7), and overall survival 79.8% (95% CI: 69.2–90.4) with a median follow-up interval of 29 months (range 15–74 months). Cox proportional-hazards model revealed that infiltration of the clivus and serum level of LDH before treatment were the most two important factors that predict distant metastases. Infiltration of the clivus and the serum LDH level greater than 410 U/L were strongly associated with distant metastasis–free survival (p = 0.0004 and p = 0.0002, respectively). When these two risk factors were considered together, no distant metastasis was observed in 40 patients with both intact clivus and LDH ≦410 U/L. On the contrary, 13 of the remaining 34 patients with at least one risk factor developed distant metastasis (p = 0.0001).Conclusion: Our study demonstrates that CCRT can improve the primary tumor control of 96.7% and disease-free survival of 77.0% at 3-year follow-up. Distant metastasis, however, is the major cause of failure. Infiltration of the clivus by the tumor and LDH greater than 410 U/L are the two independent and useful prognostic factors in patients with locoregionally advanced NPC who were treated with CCRT. Good- and poor-risk patients can be distinguished by virtue of their having both conditions.     

鼻咽癌的放化疗现状

调强放疗(IMRT)在剂量学和放射生物效应方面较传统放疗技术具有优势,已成为鼻咽癌放疗的主流.中晚期鼻咽癌单纯放疗的疗效较差,放化疗综合治疗可显著提高疗效.目前同步放化疗逐渐成为局部晚期鼻咽癌的标准治疗模式,但诱导化疗和辅助化疗的价值及其与同步放化疗之间的不同组合模式有待明确.