METHODS: A total of 300 patients with NPMM treated between March 2009 and January 2020 were divided into surgery alone (SA; 158 patients) and surgery plus radiation therapy (SR; 142 patients) groups. Postoperative radiation therapy was recommended, with a total dose of 65 to 70 Gy/30 to 35 fractions to the gross tumor volume and 60 Gy/30 fractions to the clinical target volume. The primary endpoint was relapse-free survival. Secondary endpoints included local recurrence-free survival, distant metastasis-free survival, and overall survival.
RESULTS: At a median follow-up of 50.0 months, relapse-free survival in the SA and SR groups was 9.8 and 15.2 months (hazard ratio [HR], 0.714; 95% CI, 0.546-0.933; P = .014). Distant metastasis-free survival in the SA and SR groups was 23.8 and 21.3 months (HR, 0.896; 95% CI, 15.7-31.9 vs 13.3-29.3; P = .457). Overall survival in the SA and SR groups was 31.0 and 35.1 months (HR, 0.816; 95% CI, 25.7-36.3 vs 27.1-43.2; P = .178). For patients with stage IVA NPMM, radiation therapy reduced the incidence of relapse by 0.43-fold.
CONCLUSIONS: Postoperative radiation therapy played a crucial role in the local control of resected NPMM, especially in patients with stage T4a or IVA disease.
方法:2009年3月至2020年1月期间,共300例NPMM患者被分为SA(单纯手术,158名患者)和SR(手术加放疗,142名患者)组。建议术后放疗,GTV的总剂量为65-70Gy/30-35fx(总肿瘤体积),CTV的总剂量为60Gy/30分(临床目标体积)。主要终点是无复发生存期(RFS)。次要终点包括无局部复发生存期,无远处转移生存期(DMFS),总生存率(OS)。
结果:中位随访时间为50.0个月,SA和SR组的RFS分别为9.8和15.2个月(HR:0.714,95%CI:0.546-0.933,P=0.014)。SA和SR组的DMFS分别为23.8和21.3个月(HR:0.896,95%CI:15.7-31.9vs.13.3-29.3,P=0.457)。SA和SR组的OS分别为31.0和35.1个月(HR:0.816,95%CI:25.7-36.3vs.27.1-43.2,P=0.178)。对于IVANPMM阶段的患者,放疗使复发率降低了0.43倍.
结论:术后放疗在切除的NPMM的局部控制中起着至关重要的作用。特别是在T4a或IVA疾病的患者中。