鼻咽癌选择性淋巴结照射剂量降至45 Gy：一项具有5年结局的大型队列研究
De-escalating elective nodal irradiation dose to 45 Gy in nasopharyngeal carcinoma: A large-cohort study with 5-year outcomes.
文献信息
| PMID | 42790787 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Xinlan Chen |
| 作者单位 | Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China. |
| 期刊 | Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology |
| SCI 分区 | Q1 |
| IF | 5.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
目的： 尽管近期指南推荐对鼻咽癌（NPC）采用降级选择性淋巴结照射（ENI），但最佳剂量仍未确定（45–52.6 Gy，2 Gy分次，EQD2）。我们在真实世界队列中评估了45 Gy EQD2 ENI剂量的长期疗效，以期为剂量优化和指南完善提供依据。
材料与方法： 筛选在本机构接受调强放疗（IMRT）并接受45 Gy EQD2 ENI剂量的新诊断、非转移性NPC患者。评估区域控制（RC）、总生存（OS）、局部控制（LC）和远处控制（DC）。对20例随机选取的重新计划病例，在相同靶体积和危及器官（OAR）约束条件下，进行45 Gy与50 Gy EQD2计划的剂量学比较。推导主要毒性的正常组织并发症概率（NTCP）率，以预测临床获益。
结果： 共纳入752例患者。中位随访68个月，5年RC、LC、DC和OS率分别为97.3%、96.1%、90.6%和89.7%。23例患者发生区域复发；其中14例位于淋巴结临床靶体积内，包括11例原位淋巴结大体靶体积复发和5例孤立失败（0.7%）位于45 Gy体积内。与50 Gy EQD2计划相比，45 Gy EQD2计划显著降低了所有相关OAR的剂量（P < 0.001）。腮腺功能丧失、吞咽困难和甲状腺功能减退的中位NTCP降低均具有统计学意义（均P < 0.001）。
结论： 45 Gy EQD2 ENI剂量可提供良好的长期疗效，同时具有更优的OAR保护并降低NTCP，支持在NPC中进一步前瞻性评估这一降级策略。
英文摘要
PURPOSE: Although recent guidelinesrecommend de-escalatedelective nodal irradiation (ENI) for nasopharyngeal carcinoma (NPC), the optimal dose remains undefined (45-52.6 Gy dose in 2 Gy fractions, EQD2). Weevaluated the long-term efficacy of 45-Gy EQD2 ENI dose in a real-world cohortto inform dose optimization and guideline refinement.
MATERIALS AND METHODS: Newly diagnosed, non-metastatic NPC patients treated with intensity-modulated radiotherapy (IMRT) and received 45-Gy EQD2 ENI dose at our institution were screened. Regional control (RC), overall survival (OS), local control (LC), and distant control (DC)were evaluated. Dosimetric comparisons between 45-Gy and 50-Gy EQD2 plans were performed on 20 randomly selected replanned cases using identical target volumes and organs at risk (OARs) constraints. Normal tissue complication probability (NTCP) rates for major toxicities were derived to predict clinical benefit.
RESULTS: Totally,752 patients were included. With a median follow-up of 68 months, the 5-year RC, LC, DC, and OS rates were 97.3 %, 96.1 %, 90.6 %, and 89.7 %, respectively. Regional recurrence occurred in 23 patients; 14 were within the nodal clinical target volume, including 11 in-situ nodal gross target volume relapses and five isolated failures (0.7 %) within the 45-Gy volume. The 45-Gy EQD2 plan significantly reduced dose to all relevant OARs (P < 0.001) compared with 50-Gy EQD2 plan. Significant median NTCP reductions were observed for parotid gland function loss, dysphagia and hypothyroidism (all P < 0.001).
CONCLUSION: A 45-Gy EQD2 ENI dose provides favorable long-termefficacywith superior OAR sparing and reduced NTCP, supporting further prospective evaluation of this de-escalation strategy in NPC.