鼻咽癌小靶区调强放疗及化疗的远期疗效分析

目的 分析鼻咽癌(NPC)缩小临床靶区调强放疗(IMRT)的长期疗效，为小靶区IMRT技术在NPC中应用提供依据。方法 2003-2007年接受IMRT的鼻咽癌患者413例，中位年龄45岁，男311例、女102例。按第6版AJCC分期标准Ⅰ期3例、Ⅱ期66例、Ⅲ期235例、Ⅳ_a期78例、Ⅳ_b期31例。336例患者接受了以铂类为基础的化疗。结果 随访率100%，5年总生存率、局部控制率、无区域复发生存率、无远处转移生存率和无瘤生存率分别为80%、93%、96%、81%和75%。多因素分析提示T分期、N分期、年龄是影响总生存的预后因素(P=0.001、0.001、0.002)，T分期、N分期是无远处转移生存的预后因素(P=0.000、0.001)。进展期鼻咽癌患者中诱导化疗组5年总生存有高于无诱导化疗组趋势(78%∶68%，P=0.053)，辅助化疗者5年无远处转移生存率低于无辅助化疗者(65%∶83%，P=0.003)。结论 鼻咽癌小靶区IMRT技术安全可靠，远期疗效理想。

Long-term outcome of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiotherapy and chemotherapy

Objective To analyze the long-term outcome of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) with reduced clinical target volume (CTV)and to provide a basis for the application of reduced-volume IMRT in the treatment of NPC. MethodsBetween November 2003 and April 2007, 413 patients with NPC were treated with IMRT according our institutional protocol. The median age was 45 years;the patients included 311 males and 102 females. Of all patients, 3(0.7%) had stage Ⅰ NPC, 66(16%) had stage Ⅱ NPC, 235(56.9%) had stage Ⅲ NPC, 78(18.9%) had stage Ⅳ_a NPC, and 31(7.5%) had stage Ⅳ_b NPC, according to the 6^th edition of AJCC staging system. IMRT was delivered as follows:GTV 66.00-69.75 Gy/30-33 f;CTV-1 60.00-66.65 Gy/30-33 f;CTV-2/CTV-N 54.0-55.8 Gy/30-33 f. A total of 336 patients received cisplatin-based chemotherapy in addition to IMRT. Results The follow-up rate was 100%. With a median follow-up of 72 months, the 5-year overall survival (OS), local control, loco-regional recurrence-free survival, distant metastasis-free survival (DMFS), and disease-free survival rates were 80%, 93%, 96%, 81%, and 75%, respectively. The multivariate analysis revealed that T stage, N stage, and age were independent prognostic factors for OS (P=0.001,0.001,0.002);T stage and N stage were independent prognostic factors for DMFS (P=0.000,0.001). Among patients with stage Ⅲ and IV NPC, the 5-year OS rate was nonsignificantly higher in those treated with induction chemotherapy than in those not treated with induction chemotherapy (78% vs. 68%, P=0.053), but the 5-year DMFS rate was significantly lower in those treated with adjuvant chemotherapy than in those not treated with adjuvant chemotherapy (65% vs. 83%, P=0.003). Conclusions IMRT with reduced CTV is safe and reliable and can lead to a good long-term outcome in patients with NPC.