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首页> 外文期刊>International Journal of Radiation Oncology, Biology, Physics >Examining prognostic factors and patterns of failure in nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy: impact on future clinical trials.
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Examining prognostic factors and patterns of failure in nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy: impact on future clinical trials.

机译：伴随放疗和化疗检查鼻咽癌的预后因素和失败模式：对未来临床试验的影响。

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PURPOSE: Concomitant chemotherapy and radiotherapy (CCRT), followed by adjuvant chemotherapy, has improved the outcome of nasopharyngeal carcinoma (NPC). However, the prognosis and patterns of failure after this combined-modality treatment are not yet clear. In this report, the prognostic factors and failure patterns we observed with CCRT may shed new light in the design of future trials. METHODS AND PATIENTS: One hundred forty-nine (149) patients with newly diagnosed and histologically proven NPC were prospectively treated with CCRT followed by adjuvant chemotherapy between April 1990 and December 1997. One hundred and thirty-three (89.3%) patients had MRI of head and neck for primary evaluation before treatment. Radiotherapy was delivered either at 2 Gy per fraction per day up to 70 Gy or 1.2 Gy per fraction, 2 fractions per day, up to 74.4 Gy. Chemotherapy consisted of cisplatin and 5-fluorouracil. According to the AJCC 1997 staging system, 32 patients were in Stage II, 53 in Stage III, and 64 in Stage IV (M0). RESULTS: Univariate analysis revealed that WHO (World Health Organization) Type II histology, T4 classification, and parapharyngeal extension were poor prognostic factors for locoregional control. Multivariate analysis revealed that T4 disease was the most important adverse factor that affects locoregional control, the risk ratio being 5.965 (p = 0.02). Univariate analysis for distant metastasis revealed that T4 and N3 classifications, serum LDH level > 410 U/L (normal range, 180-460), parapharyngeal extension, and infiltration of the clivus were significantly associated with poor prognosis. Multivariate analysis, however, revealed that T4 classification and N3 category were the only two factors that predicted distant metastasis; the risk ratios were 3.994 (p = 0.02) and 3.390 (p = 0.01), respectively. Therefore, based on the risk factor analysis, we were able to identify low-, intermediate-, and high-risk patients. Low-risk patients were those without the risk factors mentioned above. They consisted of Stage II patients with T2aN0, T1N1, and T2aN1 categories and of Stage III patients with T1N2 and T2aN2 categories. Their risk of recurrence is low (4%). Intermediate-risk patients were those with at least one univariate risk factor. They are Stage II patients with T2bN0 and T2bN1 categories and Stage III patients with T2bN2 and T3N0-2 categories. The risk of recurrence is modest (18%). High-risk patients have risk factors by multivariate analysis. They are stage T4 or N3 patients. Their risk of recurrence is high (36%). CONCLUSION: Low-risk patients have an excellent outcome. Future trials should focus on reducing treatment-associated toxicities and complications and reevaluate the benefit of sequential adjuvant chemotherapy. The recurrence in treatment of intermediate-risk patients is modest; CCRT and adjuvant chemotherapy may be the best standard for them. Patients with T4 and N3 disease have poorer prognosis. Hyperfractionated radiotherapy may be considered for the T4 patients. Future study in these high-risk patients should also address the problem of distant spread of the disease.
机译：目的：伴随化疗和放疗（CCRT），再辅以化疗，已经改善了鼻咽癌（NPC）的预后。然而，这种联合方式治疗后的预后和失败模式尚不清楚。在本报告中，我们使用CCRT观察到的预后因素和失败模式可能会为将来的试验设计提供新的思路。方法和患者：1990年4月至1997年12月，对149例新诊断并经组织学证实的NPC患者进行了CCRT的前瞻性治疗，然后进行了辅助化疗。133例（89.3％）的患者进行了MRI检查。治疗前对头颈部进行初步评估。放疗以每天每部分2 Gy（最高70 Gy）或每部分1.2 Gy（每天2次，最高74.4 Gy）进行。化学疗法由顺铂和5-氟尿嘧啶组成。根据AJCC 1997分期系统，II期32例，III期53例，IV期（M0）64例。结果：单因素分析显示，WHO（世界卫生组织）II型组织学，T4分类和咽旁扩张是局部区域控制的不良预后因素。多变量分析显示，T4病是影响局部控制的最重要不利因素，风险比为5.965（p = 0.02）。对远处转移的单因素分析显示，T4和N3分类，血清LDH水平> 410 U / L（正常范围，180-460），咽旁扩张和锁骨浸润与不良预后显着相关。但是，多变量分析显示，T4分类和N3类别是预测远处转移的仅有两个因素。风险比分别为3.994（p = 0.02）和3.390（p = 0.01）。因此，基于风险因素分析，我们能够识别出低，中和高风险患者。低危患者是那些没有上述危险因素的患者。他们包括具有T2aN0，T1N1和T2aN1类别的II期患者以及具有T1N2和T2aN2类别的III期患者。他们的复发风险低（4％）。中度风险患者是指至少具有一个单因素风险因素的患者。他们是具有T2bN0和T2bN1类别的II期患者以及具有T2bN2和T3N0-2类别的III期患者。复发风险适中（18％）。通过多变量分析，高危患者具有危险因素。他们是T4或N3期患者。他们的复发风险很高（36％）。结论：低危患者预后良好。未来的试验应侧重于降低与治疗相关的毒性和并发症，并重新评估序贯辅助化疗的益处。中度风险患者的复发率不高; CCRT和辅助化疗可能是他们的最佳标准。 T4和N3病患者的预后较差。 T4患者可考虑超分割放疗。这些高危患者的未来研究也应解决该病远距离传播的问题。

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