| Jianshe Wang,Tianyou Tang,Jing Xu,Andrew Z. Wang,Liang Li,Junnian Zheng,Longzhen Zhang. Clinical role of 18F-FDG PET/CT-based simultaneous modulated accelerated radiotherapy treatment planning for locally advanced nasopharyngeal carcinoma. Oncol Transl Med, 2015, 1: 264-270. |
| 基于18F-FDG PET/CT的同步加量束流调强放疗计划在局部进展期鼻咽癌的临床作用 |
| Clinical role of 18F-FDG PET/CT-based simultaneous modulated accelerated radiotherapy treatment planning for locally advanced nasopharyngeal carcinoma |
| Received:February 22, 2015 Revised:November 18, 2015 |
| DOI：10.1007/s10330-015-0073-0 |
| 中文关键词: 鼻咽癌；同步加量束流调强放射治疗，IMRT；PET/CT；18F-FDG |
| 英文关键词: nasopharyngeal carcinoma (NPC); simultaneous modulated accelerated radiotherapy; intensity-modulated radiotherapy; positron emission tomography/computed tomography (PET/CT); ?uorine-18-?uorodeoxyglucose (18F-FDG) |
| 基金项目:国家自然科学基金项目（面上项目，重点项目，重大项目）;江苏省卫生厅课题;徐州市科技局课题 |
| Author Name | Affiliation | E-mail | | Jianshe Wang | Affiliated Hospital of Xuzhou Medical College,Cancer Institute of Xuzhou Medical College | wjsemail18@163.com | | Tianyou Tang | Affiliated Hospital of Xuzhou Medical College | tty912@163.com | | Jing Xu | Functional Lab of Xuzhou Medical College,Jiangsu,China | xujing197818@163.com | | Andrew Z. Wang | University of North Carolina-Chapel Hill, Chapel Hill, NC, USA | andrew_wang@med.unc.edu | | Liang Li | Affiliated Hospital of Xuzhou Medical College
Cancer Institute of Xuzhou Medical College,Jiangsu,China
Functional Lab of Xuzhou Medical College,Jiangsu,China
Department of Radiation Oncology,University of North Carolina-Chapel Hill,Chapel Hill,NC,USA | 46585129@qq.com | | Junnian Zheng* | Xuzhou Medical College | zhengjunnian@sina.com | | Longzhen Zhang | Affiliated Hospital of Xuzhou Medical College,Cancer Institute of Xuzhou Medical College | jsxzzlz@126.com |
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| 中文摘要: |
| 目的：比较18F-FDG PET/CT指导的剂量递增放疗与常规放疗在局部进展期鼻咽癌同步放化疗的长期局部控制、生存和晚期毒副反应。方法：48例Ⅲ～Ⅳa期鼻咽癌患者被随机分为2组：PET/CT指导的剂量递增放化疗组（A组）和常规放化疗组（B组）。剂量递增放疗是指使用同步加量束流调强放射治疗技术(SMART)，处方剂量：GTV 77Gy/32f，PTV1 64Gy/32f，PTV2 54.4Gy/32f。在B组，采用均匀剂量调强，PTV1 70Gy/35f，PTV2 58Gy/29f。同步放化疗方案：顺铂(20 mg/m2, 静滴,第1-4天)+多西他赛(75 mg/m2, 静滴，第1、8天)，在放疗第1和第4周进行，所有患者在同步治疗结束后按原方案巩固化疗2～4周期。结果：18F-FDG PET/CT显著降低GTV靶区的体积，基于PET/CT指导的83.3%（20/24）的患者GTV缩小。两组5年局部无局部复发生存率(LRFS)分别为100%和79.2% (P=0.019)，5年无病生存率（DFS）分别为95.8%和75% (P=0.018)，5年总生存率(OS)分别为95.8%和79.2% (P=0.079)，无统计学差异。晚期毒副反应两组相似，最常见的为1-2级的口干，皮下纤维化和听力丧失等，无4级晚期不良反应。结论：18F-FDG PET/CT指导的剂量递增调强放疗与常规放疗相比在局部进展期鼻咽癌的同步放化疗中有很好的耐受性并能降低局部复发。 |
| 英文摘要: |
| Objective?The aim of this study was to compare the long-term local control, overall survival, and late toxicities of positron emission tomography/computed tomography (PET/CT)-guided dose escalation radiotherapy versus conventional radiotherapy in the concurrent chemoradiotherapy treatment of locally advanced nasopharyngeal carcinoma (NPC).
Methods?A total of 48 patients with stage III–IVa NPC were recruited and randomly administered PET/CT-guided dose escalation chemoradiotherapy (group A) or conventional chemoradiotherapy (group B). The dose-escalation radiotherapy was performed using the simultaneous modulated accelerated radiotherapy technique at prescribed doses of 77 gray (Gy) in 32 fractions (f) to the gross target volume (GTV): planning target volume (PTV) 1 received 64 Gy/32 f, while PTV2 received 54.4 Gy/32 f. Patients in group B received uniform-dose intensity-modulated radiotherapy, PTV1 received 70 Gy/35 f and PTV2 received 58 Gy/29 f. Concurrent chemotherapy consisted of cisplatin [20 mg/m2 intravenous (IV) on days 1–4] and docetaxel (75 mg/m2 IV on days 1 and 8) administered during treatment weeks 1 and 4. All patients received 2–4 cycles of adjuvant chemotherapy of the same dose and drug regimen.
Results?The use of ?uorine-18-?uorodeoxyglucose (18F-FDG) PET/CT significantly reduced the treatment volume delineation of the GTV in 83.3% (20/24) of patients. The 5-year local recurrence-free survival rates of the two groups were 100% and 79.2%, respectively (P = 0.019). The 5-year disease free survival (DFS) rates were 95.8% and 75.0%, respectively (P = 0.018). The 5-year local progression-free survival and DFS rates were significantly different. The 5-year overall survival (OS) rates were 95.8% and 79.2%, respectively. Differences in OS improvement were insignificant (P = 0.079). Late toxicities were similar in the two groups. The most common late toxicities of the two arms were grade 1–2 skin dystrophy, xerostomia, subcutaneous fibrosis, and hearing loss. There were no cases of grade 4 late toxicity.
Conclusion?The use of 18F-FDG PET/CT-guided dose escalation radiotherapy is well tolerated and can reduce local recurrence rates for patients with locally advanced NPC compared to conventional chemoradiotherapy.
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