416例鼻咽癌调强放疗远期生存与影响因素分析

目的 总结鼻咽癌调强放疗(IMRT)的远期生存与影响因素。方法 本院2001—2009年采用IMRT技术治疗初程鼻咽癌患者 416例,鼻咽原发灶、阳性淋巴结的大体肿瘤体积处方剂量为 70~78 Gy,临床靶体积处方剂量为60 Gy,淋巴结阴性引流区处方剂量为 50~56 Gy。Ⅲ+Ⅳ期 333例中 187例接受以顺铂30 mg/m²每周1次为主的同期化疗。Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox法多因素预后分析。结果 随访率98.0%,随访超过 5年的 158例。影响总生存的因素有性别(χ²=4.59,P=0.03)、年龄(χ²=11.20,P=0.00)、T分期(χ²=19.40,P=0.00),N分期(χ²=18.00,P=0.00),T分期影响局部控制(χ²=34.80,P=0.00),T分期、N分期均影响无瘤生存率和无远处转移生存(χ²=33.50、21.20,P=0.00、0.00和 χ²=11.90、14.60,P=0.01、0.01)。Ⅲ+Ⅳ期 333例中同期放化疗(187例)和单纯放疗(146例)的 5年局部控制率为82.2%和90.7%(χ²=1.72, P=0.19)、总生存率为70.2%和83.4%(χ²=1.42,P=0.23)、无瘤生存率为62.8%和73.2%(χ²=2.83,P=0.09)、无远处转移生存率为78.0%和83.2%(χ²=0.37,P=0.55)。结论 鼻咽癌IMRT取得较好疗效,但同期化疗的作用仍有待进一步证实。

Nasopharyngeal carcinoma treated by intensity-modulated radiotherapy: long-term results of 416 patients

Objective To summarize the long term outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy. Methods From Nov 2001 to Dec 2009, totally 416 newly diagnosed NPC patients was treated in our hospital. The prescribed dose was 70－78 Gy to the gross tumor volume and 70 Gy to the positive neck nodes, 60 Gy to the clinical target volume, and 50－56 Gy to the clinically negative neck. Among 333 stage Ⅲ/Ⅳ patients according to the 2010 UICC staging system, 187 received concurrent chemoradiotherapy with a regimen of weekly cisplatin 30 mg/m².Local control rate (LC), overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were estimated using the Kaplan-Meier method. Results The follow up rate is 98.0%.158 patients was followed up more than 5 years. The 5 years LC, OS, DFS and DMFS of whole group were 87.7%,82.1%,71.8% and 84.5%. Sex, Age, T stage and N stage were independent prognostic factors for OS (χ²=4.59,11.20,19.40,18.00, P=0.03,0.00,0.00,0.00), T and N stage were independent prognostic factors for DFS (χ²=33.50,21.20,P=0.00,0.00) and DMFS (χ²=11.90,14.60,P=0.01,0.01). The 5 years LC, OS, DFS and DMFS for local-regional advanced disease with or without concurrent chemotherapy was 82.2% and 90.7%(χ²=1.72,P=0.19),70.2% and 83.4%(χ²=1.42, P=0.23), 62.8% and 73.2%(χ²=2.83, P=0.09),78.0% and 83.2%(χ²=0.37,P=0.55) respectively. Conclusions The long term outcomes of nasopharyngeal carcinoma treated by intensity-modulated radiotherapy was encouraged. The role of concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma treated by intensity-modulated radiotherapy needs further investigated.