Preliminary Results of Intensity-Modulated Radiotherapy in the Treatment of Nasopharyngeal Carcinoma

鼻咽癌患者接受強度調控放射治療之初步結果

常佑康(You-Kang Chang) ； 黃經民(Jing-Min Hwang) ； 張秋雄(Chiou-Shiung Chang) ； 吳賜猛(Semon Wu)

《放射治療與腫瘤學》 17卷2期 (2010/06) Pp. 101-112

https://doi.org/10.6316/TRO/201017(2)101

摘要

目的：報告我們以強度調控放射治療鼻咽癌之初步結果。
材料與方法：於2005年5月至2008年7月間，共有58位鼻咽癌患者於佛教慈濟綜合醫院台北分院接受治癒性強度調控放射治療。病人性別為17位女性，41位男性；中位年齡為51.5歲（範圍27至88歲）。腫瘤分期為第一期3位(5%)、第二期12位(21%)、第三期29位(50%)及第四期14位(24%)。由多葉準直儀以動態方式執行強度調控放射治療。31位病人接受cisplatin及5FU之同步化學治療；17位病人僅接受cisplatin。31位病人接受cisplatin及5FU之輔助性化學治療。原發腫瘤及轉移淋巴節之治療劑量為66-72Gy，未有轉移淋巴節區域之治療劑量為46.8-50Gy。我們以Radiation Therapy Oncology Group (RTOG)副作用分級記錄急性及晚期副作用。以Kaplan-Meier方法計算局部控制存活率、局部及淋巴控制存活率、無轉移存活率及整體存活率。
結果：中位追蹤期為19.3個月（範圍7至41個月）。局部復發病例數為11位，淋巴復發病例數為7位，遠端轉移病例數為7位，其中6位病人已死亡。二年局部控制存活率為78%、局部及淋巴控制存活率為74%、無轉移存活率為85%及整體存活率為86%。多變數分析顯示，腫瘤分期為唯一影響局部及淋巴復發的因素。強度調控放射治療合併cisplatin及5FU同步化學治療與僅合併使用cisplatin有相似之治療結果，但急性副作用較嚴重。強度調控放射治療後19.3個月（中位數），病患口乾程度為第3級7%、第2級41%、第1級26%、第0級2%。
結論：本研究為以強度調控放射治療治療鼻咽癌之初步報告。應考慮比較合併cisplatin及5FU同步化學治療與僅合併使用cisplatin之差別。累積較多病例數及較長之追蹤時間有助於確立本研究之結果。

關鍵字

鼻咽癌 ； 強度調控放射治療 ； 同步化學治療

並列摘要

Purpose: To report our initial experience with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma (NPC).
Materials and Methods: Between May 2005 and July 2008, 58 patients underwent definitive IMRT for NPC in the Buddhist Tzu Chi General Hospital, Taipei Branch. There were 17 females and 41 males, with a median age of 51.5 (range 27-88). The disease was Stage Ⅰ in 3 (5%), Stage Ⅱ in 12 (21%), Stage Ⅲ in 29 (50%), and Stage Ⅳ in 14 (24%). IMRT was delivered using a dynamic multileaf collimator. Thirty-one patients received concomitant cisplatin and 5FU, and seventeen patients received concomitant cisplatin. Among them, thirty-one patients received adjuvant cisplatin and 5-FU chemotherapy. The prescribed dose was 66-72 Gy to the gross tumor volume and positive neck nodes, 46.8-50 Gy to the clinically negative neck. Acute and late normal tissue effects were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. The local control, local-regional control, distant metastasis-free, and the overall survival rates were calculated using the Kaplan-Meier method.
Results : With a median follow-up of 19.3 months (range 7 to 41 months), there were 11 local recurrences at the primary site. Seven patients failed in the neck. Seven patients developed distant metastases; 6 of these patients died. The 2-year local control, local-regional control, and distant metastases-free rates were 78%, 74%, and 85% respectively. The 2-year overall survival was 86%. With 11 and 13 patents experiencing local and locoregional failure, only stage of disease was a significant predictor by multivariate analysis. IMRT with concomitant cisplatin and 5FU had treatment outcomes similar to IMRT with concomitant cisplatin alone, but this regimen was associated with more severe acute toxicity. At 19.3 months (median) after IMRT, 7% of the patients had Grade 3 xerostomia, 41% had Grade 2, 26% had Grade 1 and 2% had no xerostomia.
Conclusion: Our preliminary results using IMRT for treatment of NPC were reported. Further study to compare concomitant cisplatin and 5FU with cisplatin alone is warranted. A larger case number and longer follow-up time were needed to confirm our preliminary results.

並列關鍵字

Nasopharyngeal carcinoma ； Intensity-modulated radiotherapy ； Concomitant chemotherapy