PDF(Pubmed)
Abstract：
OBJECTIVE: Intensity-modulated radiotherapy (IMRT) combined with concurrent chemotherapy is deemed as the mainstay treatment in locoregionally advanced nasopharyngeal carcinoma (NPC). Nevertheless, the tolerance of severe acute toxicity of concurrent chemotherapy was unsatisfied. In addition, T4 is the predicting factor of poor prognosis for NPC patients. In this retrospective analysis, the long-term outcomes IMRT combined by induction chemotherapy deleting concurrent chemotherapy with or without adjuvant chemotherapy for T4 non-metastatic NPC were analyzed.
METHODS: From January 2005 to November 2016, a total of 145 biopsy-proven non-metastatic T4 NPC was treated with IMRT combined by induction chemotherapy with or without adjuvant chemotherapy. The survival and side effects of the patients were analyzed.
RESULTS: Median follow-up time was 74 months (ranges, 8-186 months). 10.0%, 61.3%, 27.3%, and 1.3% developed grade 1, 2, 3, and 4 mucositis during IMRT, respectively. 5.5% and 2.0% patients experienced grade 1 and 2 nausea and vomiting; no patients developed grade 3 or 4 nausea and vomiting. Of 145 patients enrolled, 5-year and 10-year overall survival(OS) rates were 73.7% and 53.9%, local progression-free survival(LPFS) rates were 86.1% and 71.6%, regional progression-free survival(RPFS) rates were 96.7% and 92.8%, distant metastasis-free survival (DMFS) rates were 86.7%, 78.2%, respectively. At the last follow-up, five patients developed cranial nerve injury, one patient developed mandibular bone necrosis, four patients developed temporal lobe injury, four patients developed nasopharyngeal massive hemorrhage (three cases after recurrence and one case without recurrence), and five patients developed second primary tumor.
CONCLUSIONS: The survival outcomes of treating T4 NPC IMRT combined by induction chemotherapy deleting concurrent chemotherapy with or without adjuvant chemotherapy are encouraging. Moreover, mucosal reaction, nausea, and vomiting reaction were reduced during IMRT.
METHODS: From January 2005 to November 2016, a total of 145 biopsy-proven non-metastatic T4 NPC was treated with IMRT combined by induction chemotherapy with or without adjuvant chemotherapy. The survival and side effects of the patients were analyzed.
RESULTS: Median follow-up time was 74 months (ranges, 8-186 months). 10.0%, 61.3%, 27.3%, and 1.3% developed grade 1, 2, 3, and 4 mucositis during IMRT, respectively. 5.5% and 2.0% patients experienced grade 1 and 2 nausea and vomiting; no patients developed grade 3 or 4 nausea and vomiting. Of 145 patients enrolled, 5-year and 10-year overall survival(OS) rates were 73.7% and 53.9%, local progression-free survival(LPFS) rates were 86.1% and 71.6%, regional progression-free survival(RPFS) rates were 96.7% and 92.8%, distant metastasis-free survival (DMFS) rates were 86.7%, 78.2%, respectively. At the last follow-up, five patients developed cranial nerve injury, one patient developed mandibular bone necrosis, four patients developed temporal lobe injury, four patients developed nasopharyngeal massive hemorrhage (three cases after recurrence and one case without recurrence), and five patients developed second primary tumor.
CONCLUSIONS: The survival outcomes of treating T4 NPC IMRT combined by induction chemotherapy deleting concurrent chemotherapy with or without adjuvant chemotherapy are encouraging. Moreover, mucosal reaction, nausea, and vomiting reaction were reduced during IMRT.
摘要：
目的：调强放疗（IMRT）联合同步化疗被认为是局部晚期鼻咽癌（NPC）的主要治疗方法。然而，同步化疗对严重急性毒性的耐受性不满意。此外,T4是鼻咽癌患者预后不良的预测因素。在这个回顾性分析中,我们分析了IMRT联合诱导化疗删除同步化疗加或不加辅助化疗治疗T4非转移性NPC的长期结局.
方法：从2005年1月至2016年11月，共145例活检证实的非转移性T4鼻咽癌患者接受IMRT联合诱导化疗或不联合辅助化疗。分析患者的生存和副作用。
结果：中位随访时间为74个月（范围，8-186个月）。10.0%,61.3%,27.3%,1.3%的人在IMRT期间发展为1、2、3和4级粘膜炎，分别。5.5%和2.0%的患者出现1级和2级恶心和呕吐；没有患者出现3级或4级恶心和呕吐。在145名患者中，5年和10年总生存率（OS）分别为73.7%和53.9%，局部无进展生存率（LPFS）分别为86.1%和71.6%，区域无进展生存率（RPFS）分别为96.7%和92.8%，无远处转移生存率（DMFS）为86.7%，78.2%,分别。在最后一次随访中，5例患者出现脑神经损伤,一名患者出现下颌骨坏死,四名患者出现颞叶损伤，4例患者发生鼻咽大出血（复发3例，无复发1例），5例患者发展为第二原发肿瘤。
结论：通过诱导化疗消除同步化疗加或不加辅助化疗治疗T4鼻咽癌IMRT的生存结果令人鼓舞。此外，粘膜反应，恶心,IMRT期间呕吐反应减少。
方法：从2005年1月至2016年11月，共145例活检证实的非转移性T4鼻咽癌患者接受IMRT联合诱导化疗或不联合辅助化疗。分析患者的生存和副作用。
结果：中位随访时间为74个月（范围，8-186个月）。10.0%,61.3%,27.3%,1.3%的人在IMRT期间发展为1、2、3和4级粘膜炎，分别。5.5%和2.0%的患者出现1级和2级恶心和呕吐；没有患者出现3级或4级恶心和呕吐。在145名患者中，5年和10年总生存率（OS）分别为73.7%和53.9%，局部无进展生存率（LPFS）分别为86.1%和71.6%，区域无进展生存率（RPFS）分别为96.7%和92.8%，无远处转移生存率（DMFS）为86.7%，78.2%,分别。在最后一次随访中，5例患者出现脑神经损伤,一名患者出现下颌骨坏死,四名患者出现颞叶损伤，4例患者发生鼻咽大出血（复发3例，无复发1例），5例患者发展为第二原发肿瘤。
结论：通过诱导化疗消除同步化疗加或不加辅助化疗治疗T4鼻咽癌IMRT的生存结果令人鼓舞。此外，粘膜反应，恶心,IMRT期间呕吐反应减少。
