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

鼻咽癌颅底侵犯调强放射治疗的优越性。

  • 影响因子:3.23
  • DOI:10.1007/s00432-019-03067-y
  • 作者列表:"Liao S","Xie Y","Feng Y","Zhou Y","Pan Y","Fan J","Mi J","Qin X","Yao D","Jiang W
  • 发表时间:2020-02-01
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.

摘要

目的: 比较鼻咽癌二维常规放射治疗 (2DRT) 和调强放射治疗 (IMRT) 的临床结果和功能结果。颅底入侵。 方法: 将 1258 例患者分为轻度颅底侵犯组 (792; 63%) 和重度颅底侵犯组 (466; 37%)。使用 6 个临床因素对 2DRT或IMRT组进行配对 (1:1 比)。Kaplan-Meier法和Cox回归模型评估总生存期 (OS) 、无病生存期 (DFS) 、局部区域无复发生存期 (LRRFS) 和无远处转移生存期 (DMFS)。评价毒性。 结果: 与 2DRT相比,IMRT显著改善了 4 年OS (65.6% vs. 81.8%,p = 0.000),DFS (57.3% vs. 73.3%,p = 0.000) 和LRRFS (76.5% vs. 87.5%,p = 0.003),但在轻度颅底侵犯患者中观察到类似的结果 (p> 0.05)。在严重侵袭的患者中,放射治疗技术是OS (hr = 0.457,p = 0.000) 、DFS (hr = 0.547,P = 0.000) 和LRRFS (hr = 0.503,p = 0.004)。IMRT与更好的OS相关。在亚组分析中,IMRT组在OS、DFS方面也有较好的生存率 (p <0.05) 对于接受同步化疗和序贯化疗的患者,与严重侵袭组的 2DRT相比。IMRT组黏膜炎、口干、牙关紧闭 (<1厘米) 、颞叶坏死的发生率低于 2DRT组。 结论: IMRT与 2DRT相比,在重度颅底浸润的鼻咽癌患者中显著改善了患者生存率,但在轻度浸润的患者中观察到相似的生存率。化疗可提高严重侵袭的鼻咽癌患者的生存率。在两种治疗中,IMRT显著降低了治疗相关毒性。

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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