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Journal of Cancer Research and Clinical Oncology

Erschienen in:

01.11.2019 | Original Article – Clinical Oncology

Superiority of intensity-modulated radiation therapy in nasopharyngeal carcinoma with skull-base invasion

verfasst von: Shufang Liao, Yuan Xie, Yi Feng, Yuanyuan Zhou, Yufei Pan, Jinfang Fan, Jinglin Mi, Xiaoli Qin, Dacheng Yao, Wei Jiang

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 2/2020

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Abstract

Purpose

To compare the clinical results and functional outcomes between two-dimensional conventional radiation therapy (2DRT) and intensity-modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC) with skull-base invasion.

Methods

A total of 1258 patients were subclassified into two groups: mild skull-base invasion group (792; 63%) and severe skull-base invasion group (466; 37%). Patients were pair matched (1:1 ratio) using six clinical factors into 2DRT or IMRT groups. The Kaplan–Meier method and Cox regression model were performed to assess overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS). Toxicities were evaluated.

Results

IMRT significantly improved four-year OS compared with 2DRT (65.6% vs. 81.8%, P = 0.000), DFS (57.3% vs. 73.3%, P = 0.000) and LRRFS (76.5% vs. 87.5%, P = 0.003) in NPC with severe skull-base invasion, but similar results were observed in patients with mild skull-base invasion (P > 0.05). In patients with severe invasion, radiation therapy techniques were found to be an independent prognostic factor for OS (HR = 0.457, P = 0.000), DFS (HR = 0.547, P = 0.000) and LRRFS (HR = 0.503, P = 0.004). IMRT was associated with better OS. In subgroups analysis, IMRT group also had a better survival in OS, DFS (P < 0.05 for all rates) for patients received concurrent chemotherapy and sequential chemotherapy compared to 2DRT in the severe invasion group. The IMRT group displayed lower incidence of mucositis, xerostomia, trismus (< 1 cm) and temporal lobe necrosis than the 2DRT group.

Conclusions

IMRT significantly improved patient survival compared with 2DRT in NPC patients with severe skull-base invasion, but a similar survival rate was noted in mild invasion patients. Chemotherapy can improve survival in NPC patients with severe invasion. Among the two therapies, IMRT significantly decreased therapy-related toxicity.

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Titel: Superiority of intensity-modulated radiation therapy in nasopharyngeal carcinoma with skull-base invasion
verfasst von: Shufang Liao
Yuan Xie
Yi Feng
Yuanyuan Zhou
Yufei Pan
Jinfang Fan
Jinglin Mi
Xiaoli Qin
Dacheng Yao
Wei Jiang
Publikationsdatum: 01.11.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Cancer Research and Clinical Oncology / Ausgabe 2/2020
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-019-03067-y

Springer Medizin

Superiority of intensity-modulated radiation therapy in nasopharyngeal carcinoma with skull-base invasion