CAJ | 학술논문

目的分析鼻咽癌(NPC)缩小临床靶区调强放疗(IMRT)的长期疗效,为小靶区IMRT技术在NPC中应用提供依据.方法 2003-2007年接受IMRT的鼻咽癌患者413例,中位年龄45岁,男311例、女102例.按第6版AJCC分期标准Ⅰ期3例、Ⅱ期66例、Ⅲ期235例、Ⅳa期78例、Ⅳb期31例.336例患者接受了以铂类为基础的化疗.结果随访率100％,5年总生存率、局部控制率、无区域复发生存率、无远处转移生存率和无瘤生存率分别为80％、93％、96％、81％和75％.多因素分析提示T分期、N分期、年龄是影响总生存的预后因素(P=0.001、0.001、0.002),T分期、N分期是无远处转移生存的预后因素(P=0.000、0.001).进展期鼻咽癌患者中诱导化疗组5年总生存有高于无诱导化疗组趋势(78％∶68％,P =0.053),辅助化疗者5年无远处转移生存率低于无辅助化疗者(65％∶83％,P =0.003).结论鼻咽癌小靶区IMRT技术安全可靠,远期疗效理想.
목적 분석비인암(NPC)축소림상파구조강방료(IMRT)적장기료효,위소파구IMRT기술재NPC중응용제공의거.방법 2003-2007년접수IMRT적비인암환자413례,중위년령45세,남311례、녀102례.안제6판AJCC분기표준Ⅰ기3례、Ⅱ기66례、Ⅲ기235례、Ⅳa기78례、Ⅳb기31례.336례환자접수료이박류위기출적화료.결과 수방솔100％,5년총생존솔、국부공제솔、무구역복발생존솔、무원처전이생존솔화무류생존솔분별위80％、93％、96％、81％화75％.다인소분석제시T분기、N분기、년령시영향총생존적예후인소(P=0.001、0.001、0.002),T분기、N분기시무원처전이생존적예후인소(P=0.000、0.001).진전기비인암환자중유도화료조5년총생존유고우무유도화료조추세(78％∶68％,P =0.053),보조화료자5년무원처전이생존솔저우무보조화료자(65％∶83％,P =0.003).결론 비인암소파구IMRT기술안전가고,원기료효이상.
Objective To analyze the long-term outcome of nasopharyngeal carcinoma (NPC)patients treated with intensity-modulated radiotherapy (IMRT) with reduced clinical target volume (CTV)and to provide a basis for the application of reduced-volume IMRT in the treatment of NPC.Methods Between November 2003 and April 2007,413 patients with NPC were treated with IMRT according our institutional protocol.The median age was 45 years;the patients included 311 males and 102 females.Of all patients,3(0.7％) had stage Ⅰ NPC,66(16％) had stage Ⅱ NPC,235(56.9％) had stage Ⅲ NPC,78(18.9％) had stage Ⅳa NPC,and 31 (7.5％) had stage Ⅳb NPC,according to the 6th edition of AJCC staging system.IMRT was delivered as follows:GTV 66.00-69.75 Gy/30-33 f; CTV-1 60.00-66.65Gy/30-33 f; CTV-2/CTV-N 54.0-55.8 Gy/30-33 f.A total of 336 patients received cisplatin-based chemotherapy in addition to IMRT.Results The follow-up rate was 100％.With a median follow-up of 72months,the 5-year overall survival (OS),local control,loco-regional recurrence-free survival,distant metastasis-free survival (DMFS),and disease-free survival rates were 80％,93％,96％,81％,and 75％,respectively.The multivariate analysis revealed that T stage,N stage,and age were independent prognostic factors for OS (P =0.001,0.001,0.002) ; T stage and N stage were independent prognostic factors for DMFS (P =0.000,0.001).Among patients with stage Ⅲ and Ⅳ NPC,the 5-year OS rate was nonsignificantly higher in those treated with induction chemotherapy than in those not treated with induction chemotherapy (78％ vs.68％,P =0.053),but the 5-year DMFS rate was significantly lower in those treated with adjuvant chemotherapy than in those not treated with adjuvant chemotherapy (65％ vs.83％,P =0.003).Conclusions IMRT with reduced CTV is safe and reliable and can lead to a good long-term outcome in patients with NPC.