Clinical treatment considerations in the intensity-modulated radiotherapy era for patients with N0-category nasopharyngeal carcinoma and enlarged neck lymph nodes

摘要:

Background: Nasopharyngeal carcinoma (NPC) shows a high proportion of lymph node metastasis, and treatment guidelines have been developed for positive nodes. However, no irradiation guidelines have been proposed for patients with enlarged neck lymph nodes (ENLNs) that do not meet the radiological criteria of 10 mm in diameter for positive lymph nodes. This study aimed to determine the prognostic value and radiation dose for ENLNs in N0-cate-gory NPC patients treated with intensity-modulated radiotherapy (IMRT). Methods: We reviewed the medical data of 251 patients with non-metastatic, N0-category NPC treated with IMRT. Receiver operating characteristic curves were used to calculate the cut-off value of the ENLN diameter for the prediction of disease failure.The biological equivalent dose (BED) for ENLNs was calculated. Patient survival was compared between the smal and large ENLN groups. Independent prognostic factors were identified using the Cox proportional hazards model. Results: The estimated 4-year regional relapse-free survival rate was higher in patients with ENLNs ≥5.5 mm thanin those with ENLNs <5.5 mm (100% vs. 98.8%, P= 0.049), whereas disease-free, overall, and distant metastasis-free survival rates were similar between the two groups. After adjusting for various factors, ENLN diameter was not identi-fied as an independent prognostic factor (P > 0.05 for all survival rates). In the subgroup analysis, patients receiving BED ≥72 Gy had a similar prognosis as patients receiving BED <72 Gy in both the small and large ENLN groups. Themultivariate analysis also confirmed that BED≥72 Gy was not associated with significantly improved prognosis in patients with N0-category NPC. Conclusions: A BED of 72 Gy to ENLNs is considerably sufficient to provide a clinical benefit to patients with N0-cate-gory NPC. Prospective studies are warranted to validate the findings in the present study.

更多
作者单位: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guang-zhou 510060, Guangdong, P. R. China;Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China [1] State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guang-zhou 510060, Guangdong, P. R. China;Imaging Diagnosis and Interventional Center, Sun Yat-sen Univer-sity Cancer Center, Guangzhou 510060, Guangdong, P. R. China [2] State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guang-zhou 510060, Guangdong, P. R. China;Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China;State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guang-zhou 510060, P. R. China [3]
期刊: 《癌症(英文版)》2017年36卷7期 306-314页 ISTICCA
栏目名称: Original Article
DOI: 10.1186/s40880-017-0199-2
基金项目:
grants from the Health & Medical Collaborative Innovation Project of Guangzhou City, China the Sun Yat-sen University Clinical Research 5010 Program the Science and Technology Project of Guangzhou City, China the Planned Science and Technology Project of Guangdong Province, China (No. 2013B020400004). We thank Ai-Hua Lin for the assistance in statistics and data analysis
  • 浏览:3
  • 下载:1

加载中!

相似文献

  • 中文期刊
  • 外文期刊
  • 学位论文
  • 会议论文

加载中!

加载中!

加载中!

加载中!