847例放射强度调制放疗治疗鼻咽癌的效果分析：经验总结与建议

Effect analysis of 847 nasopharyngeal carcinoma cases treated with intensity modulated radiation: Experience and suggestions

ORAL ONCOLOGY

影响因子:3.9

分区:医学2区 / 牙科与口腔外科2区肿瘤学3区

发表日期:2024 Nov

作者: Wen-Jing Yin, Wu Mao, Fang Yang, Meng-Yao Wang, Jin-Quan Liu, Dong-Ping Chen, Li-Ping Zhou, Si-Da Chen, Xi-Zhen Jiang, Yu-Meng Ou, Zheng Wu, Bin Qi

DOI: 10.1016/j.oraloncology.2024.107001

摘要

旨在识别非转移性鼻咽癌（NPC）在强度调制放射治疗（IMRT）时代的失败规律和预后因素。回顾分析2012年至2016年间接受IMRT治疗的847例新诊断未转移NPC患者资料。分析其生存结局、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、远处转移无病生存率、无病生存率及总生存率分别为94.3%、95.3%、84.8%、76.5%和85.7%。主要的局部复发部位为鼻咽（91.5%，43/47）和颅底（68.1%，32/47）；其中39例发生场内失败，4例发生边缘失败，4例发生场外失败。颈部区域的最常见复发部位为Level IIb（62.2%，23/37），其次为Level IIa（35.1%，13/37）和咽后区域（32.4%，12/37）；仅场内失败的有35例，仅场外失败的有1例，同时发生场内和场外失败的有1例。TNM分期是预后最重要的预测因素。402例（47.5%）患者出现三级或四级急性不良反应，白细胞减少（31.5%）和口腔黏膜炎（26.7%）为最常见的血液学和非血液学不良反应。晚期并发症多为轻度或中度损伤，干燥症（647/847，占76.4%）和听力损伤（422/847，占49.8%）依然是主要困扰。接受IMRT治疗的鼻咽癌患者获得了令人满意的生存率。远处转移是主要的失败模式，局部区域失败主要表现为场内失败。应加强高风险远处转移患者的筛查和放疗靶区的优化研究。

Abstract

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.