Hemoglobin Level during Chemoradiation Therapy Predicts Treatment Outcome in Nasopharyngeal Cancer

鼻咽癌同步化學放射治療期間之血紅素值預估治療預後

沈秉杰(Bing-Jie Shen) ； 熊佩韋(Pei-Wei Shueng)

《放射治療與腫瘤學》 21卷2期 (2014/06) Pp. 77-87

https://doi.org/10.6316/TRO/201421(2)77

摘要

目的：本文研究鼻咽癌於化學放射治療期間之血紅素值與治療後存活率之關聯性。材料和方法：在2006年12月至2010年3月期間，納入非遠端轉移之鼻咽癌患者。放射治療計劃靶體積之原發腫瘤與陽性淋巴結給予70 Gy放射線治療劑量，以1.8 Gy至2.0 Gy分次給予。大部份病人（79.7%）接受同步cisplatin-based化學治療，部份病人並接受前導性化學治療。前導性化學治療EP-HDFL，包含Epirubicin、Cisplatin、5-FU和Leucovorin。同步化療PFL，包含Cisplatin、5-FU和Leucovorin。前導性化學治療且／或同步化學放射治療期間，每週皆測量血紅素值以評估血液學效應。結果：總計64位病患被納入，追縱期中位數為56個月。AJCC分期第三期和第四期有較差的整體存活率，分別為88.5%和58.3%。前導性化學治療中第二級貧血，與同步化學治療中第三級貧血，皆與較差的五年整體存活率相關，分別為50.0%和50.0%。在本研究中並無發生第四或第五級貧血。貧血產生的效應在單變項分析中趨於顯著。結論：除了AJCC分期，在前導性化學治療且／或同步化學放射治療期間每週測量之血紅素值，為潛在的長期治療預後指標。

關鍵字

鼻咽癌 ； 前導性化學治療 ； 化學放射治療 ； 貧血

並列摘要

Purpose: The aim of the study is to investigate the correlation between hemoglobin level during chemoradiation therapy and overall survival in nasopharyngeal cancer. Materials and Methods: Between December 2006 and March 2010, patients with nonmetastatic nasopharyngeal cancer were enrolled. Radiation consisted of at least 70 Gy to the planning target volumes of primary tumor plus any positive nodal disease using 1.8 Gy to 2.0 Gy per fraction. Most patients (79.7%) received concurrent cisplatinbased chemotherapy with or without induction chemotherapy. Induction chemotherapy regimens, EP-HDFL, consisted of Epirubicin, Cisplatin, 5-FU, and Leucovorin. Concurrent chemotherapy, PFL, consisted of Cisplatin, 5-FU, and Leucovorin. Weekly hemoglobin levels during induction chemotherapy and/or concurrent chemoradiation therapy were checked for evaluation of hematological effects. Results: Total 64 patients were enrolled with a median follow-up of 56 months. AJCC stage III and IV predicted worse 5-year overall survival rates, 88.5% and 58.3%, respectively. Both grade 2 anemia in induction chemotherapy and grade 3 anemia in concurrent chemotherapy correlated with worse 5-year overall survival rates, 50.0% and 50.0%, respectively. No grade 4 or 5 anemia occurred in this study. The effect of anemia had a trend toward significance in univariate analysis. Conclusion: Besides AJCC staging, weekly hemoglobin levels during induction chemotherapy and/or concurrent chemoradiation therapy is a potentially clinical predictor of long-term treatment outcome in nasopharyngeal cancer.

並列關鍵字

Nasopharyngeal cancer ； Induction chemotherapy ； Chemoradiation therapy ； Anemia