| BackgroundNasopharyngeal carcinoma(NPC)is an endemic malignant tumor that is a global relatively rare but high incidence in southeast Asia and southern China,especially in Guangdong Province,China,the annual incidence of about 20 to 50 cases per 100000,and it was called “Cantonese cancer”.NPC is about 2 to 3 times higher in males than in females,the age of onset from the age of 10 began to rise gradually until it peaks between 45 and 60 years old.86,700 new cases of NPC and 50,800 deaths were reported wordwide in 2012.Due to anatomic constraints and its high radiosensitivity,radiotherapy is still the primary treatment of NPC.With the development of Intensity Modulated Radiotherapy(IMRT),the 5-year Overall Survival(OS)rate for early-stage nasopharyngeal carcinoma has exceeded 90%,but only 60~85% for locoregionally advanced nasopharyngeal carcinoma.Approximately 70% to 80% of cases of newly diagnosed nasopharyngeal carcinoma are classified as locoregionally advanced disease because of its hidden of anatomical lacation,insufficience of social economy level and failed to conduct nasopharynx examination for all the people,the weak level of common people’s medical knowledge.At present,although concurrent chemoradiotherapy is the standard treatment for locoregionally advanced nasopharyngeal carcinoma,there are still 20% ~ 30% paitents with locoregional recurence or distant metastasis after standard treatment.Locoregional recurence and distant metastasis are the main reasons of treatment failture for nasopharyngeal carcinoma.To this end,seeking a new method which reduces the distant metastasis rate and locaregional recurence rate and improves the survival rate of locoregionally advanced nasopharyngeal carcinoma is the urgent concern of medical scientists.In tumor thermotherapy,there are sufficient evidences that hyperthermia combined with radiotherapy and chemotherapy can improve the efficacy of tumor therapy,and has been used in clinical practice.In recent years,local hyperthermia combined with radiotherapy and chemotherapy has achieved good curative effect in the treatment of nasopharyngeal carcinoma,but still failed to reduce the distant metastasis rate.Nearly 20 years,the clinical study of whole body hyperthermia is carried out gradually.It is used in the treatment of advanced maligant cancer mainly,and the preliminary result is encouraging.At present,there was a study suggest that whole body hyperthermia combined with radiotherapy and chemotherapy took the gratifying short-term curative effect in the treatment of locally advanced nasopharyngeal carcinoma,but the long-term efficacy observation is now zero reported.Research purposesTo observe the curative effect and adverse reactions of radiotherapy and chemotherapy combined with whole body hyperthermia in the treatment of patients with stage III / IVa,newly diagnosed,non-metastatic nasopharyngeal carcinoma.To compared with radiotherapy and chemotherapy,whether whole body hyperthermia combined with radiotherapy and chemotherapy have advantages in improving survival and reducing side effects or not.And providing reference for further clinical research and application.In addition,we explore the prognstic factors of newly diagnosed,non-metastatic locoregionally advandced nasopharygeal carcinoma.Material and MethodA retrospective analysis was made on 92 patients with stage III / IVa,newly diagnosed,non-metastatic nasopharygeal carcinoma who were collected in the Affiliated Canncer Hospital of Guanga Zhou Mdical University from July 2008 to July 2012.92 patients with stage III / IVa according to 2008 Guangzhou staging criteria,and all of them were diagnosed by nasopharyngeal biopsy for undifferentiated non-keratinizing carcinoma.Hyperthermian group(46 cases,whole body hyperthermia combined with radiotherapy and chemotherapy)and control group(46 cases,radiotherapy and chemotherapy),and the two groups of patients accepted the same chemoradiotherapy regimen.And whole body hyperthermia was given at the same time as chemotherapy.Follow-up endpoint for death,recurrence,metastasis and progress.The Complete Response(CR)rate,Overall Survival(OS),Locoregional Recurrence-Free Survival(LRRFS),Distant Metastasis-Free survival(DMFS)and Progression Free-Survival(PFS)were observed.c2 test was used to analyze qualitative data.Kaplan-Meier method was employed for survival analysis.Log-rank test was used to analyze the statistical significance in the differences among the survival curves.A multivariate analysis with Cox proportional hazards model was used to test the independent prognostic factors.Research resultFor the 3-month Complete Response(CR)rates,there were significant differences not only in the primary nasopharygeal carcinoma(CR rates: 89.1% vs 65.2%),respectively,P<0.05),but also in the cervical lymph nodes(CR rates: 80.4% vs 58.7%)between the hyperthermia and control groups.No statistical differences were observed in the survival and the cumulative incidence of acute adverse reactions between the two groups.The 5-year Overall Survival(OS)rates were 80.4% and 75.8%,with the Progression Free-Survival(PFS)rates of 69.3% and 58.7%,Locoregional Recurrence-Free Survival(LRRFS)rates of 88.3% and 82.1%,and Distant Metastasis-Free Survival(DMFS)rates of 75.7% and 73.1% in the hyperthermia group and the control group,P all>0.05.Although there was not statistical differences between the two group,the survival of hyperthermia group were better than the control group.Where stratified for stage,the 5-year OS of stage IVa,T4 and N2-3 disease in the hyperthermia group were better than the control group,P all>0.05.In univariate and multivariate analysis showed that clinical stage and N stage were the independent prognostic factors for OS and DMFS;in the control group,clinical stage was the independent prognostic factors for OS,N stage was the independent prognostic factors for DMFS;in the hyperthermia group N stage were the independent prognostic factors for OS and DMFS.Research conclusionThe retrospective study showed that whole body hyperthermia combined with radiotherapy and chemotherapy can improve the short-term curative effect obviously in the treatment of stage III / IVa nasopharyngeal carcinoma,and it does not increage the acute adverse reations.It is safe and feasible.Compared with chemoradiotherapy,whole body hyperthermia combined with radiotherapy and chemotherapy has a tendency to improve the long-term survival for stage III / IVa nasopharyngeal carcinoma.Clinical stage,N stage are poor prognostic factors affecting the Overall Survival(OS)of patients with stage III / IVa nasopharyngeal carcinoma;Clinical stage is a poor prognostic factors affecting the OS of patients with stage III / IVa nasopharyngeal carcinoma treated by radiotherapy and chemotherapy;N stage is a poor prognostic factors affecting the OS of patients with stage III / IVa nasopharyngeal carcinoma treated by radiotherapy and chemotherapy combined with whole body hyperthermia. |
PDF Full Text Request