目的 探讨调强放疗（IMRT）时代非转移性鼻咽癌（NPC）的失败模式和预后因素。对2012年至2016年间847例新诊断的非播散性鼻咽癌患者接受调强放疗（IMRT）治疗的数据进行回顾性分析。分析生存结果、失败模式和预后因素。5年局部无复发生存率、淋巴结无复发生存率、无远处转移生存率、无病生存率和总生存率分别为94.3%、95.3%、84.8分别为 %、76.5% 和 85.7%。主要局部复发部位为鼻咽部（91.5%，43/47）和颅底（68.1%，32/47）； 39 名患者出现内场故障，4 名患者出现边缘故障，4 名患者出现外场故障。 IIb级（62.2%，23/37）是最常见的区域复发部位，其次是IIa级（35.1%，13/37）和咽后区域（32.4%，12/37）；单纯场内失败35例，单纯场外失败1例，场内和场外同时失败1例。 TNM分期是预后预测最重要的因素。 402 名（47.5%）患者出现 3 级或 4 级急性不良事件；白细胞减少症（31.5%）和粘膜炎（26.7%）分别是最常见的血液学和非血液学事件。晚期并发症为轻度或中度损伤；口干症（647/847，76.4％）和听力障碍（422/847，49.8％）仍然是最麻烦的。接受IMRT治疗的鼻咽癌患者获得了满意的生存结果。关键的失败模式是远处转移。局部区域故障的主要模式是现场故障。应研究筛查远处转移的高危患者并优化放疗靶点。版权所有 © 2024 Elsevier Ltd. 保留所有权利。

To identify the failure patterns and prognostic factors of nonmetastatic nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era.Data on 847 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2012 and 2016 were retrospectively reviewed. Survival outcome, failure patterns and prognosis factors were analyzed.The 5-year local relapse-free survival, nodal relapse-free survival, distant metastasis-free survival, disease-free survival, and overall survival rates were 94.3%, 95.3%, 84.8%, 76.5% and 85.7%, respectively. The major local recurrence sites were the nasopharynx (91.5%, 43/47) and skull base (68.1%, 32/47); 39 patients had in-field failures, four had marginal failures, and four had out-field failures. Level IIb (62.2%, 23/37) was the most frequent regional recurrence site, followed by IIa (35.1%, 13/37) and retropharyngeal region (32.4%, 12/37); 35 cases had in-field failure alone, one had out-field failure alone, and one had both in- and out-field failure. TNM stage was the most significant factor for prognosis prediction. 402 (47.5%) patients had acute adverse events of grade 3 or 4; leukopenia (31.5%) and mucositis (26.7%) was the most common hematological and non-hematological event, respectively. Late complications were slight or moderate damages; xerostomia (647/847, 76.4%) and hearing impairment (422/847, 49.8%) remained the most troublesome.NPC patients treated with IMRT obtained satisfactory survival outcomes. The key failure pattern was distant metastasis. The main pattern of local-regional failure was in-field failure. Screening high risk patients with distant metastases and optimizing radiotherapy targets should be studied.Copyright © 2024 Elsevier Ltd. All rights reserved.