RESUMEN
Objective To compare the severity of sensorineural hearing impairment resulted from radiotherapy (RT) and radiochemotberapy (CRT) in patients with nasopharyngeal carcinoma (NPC). Methods Between March 2002 and May 2007, 100 initially diagnosed NPC patients in Shandong Tumor Hospital and Qi Lu Hospital were randomized to RT group and CRT group. All patients underwent intensity modulated radiation therapy. In CRT group, concurrent and adjuvant CDDP were administered (CDDP 25 mg/m2/d for 3 days to 4 cycles). Pure tone auditory threshold examination was performed 1 week ,6 months, 1 year and 2 years after the completion of radiotherapy. Statistical analyses were performed using Mann-Whit-ney U test,chi-square test and Fisber's exact probability test. Results The high-frequency threshold was significantly increased in CRT group comparing with RT group at 1- and 2-year after the treatment. In RT group, the hearing threshold was impaired immediately after the treatment, partially recovered within the first year but impaired again after 2 years. In CRT group, hearing threshold was impaired at the same time and kept getting worse until 1 year after radiotherapy, which could not be recovered. Conclusions Patients with NPC treated with radiotherapy and concurrent/adjuvant chemotherapy have more severe sensorineural hearing impairment comparing with those with radiotherapy alone, especially to the high frequency sound in the speech range. Inner ear tissue tolerance should be redefined for patients receiving radiochemotherapy.
RESUMEN
Objective To evaluate the efficacy of intensity-madulated radiotherapy(IMRT) as the primary treatment in nasopharyngeal carcinoma (NPC). Methods Between November 2001 and March 2006,147 newly diagnosed NPC patients were treated with IMRT. The disease was Stage I in 3 patients, Stage Ⅱ in 35,Stage Ⅲ in 67 and Stage Ⅳ in 42. For T1-2 disease,the prescription dose was 70 Gy to the gross tumor volume( GTVnx) and positive neck nodes ,60 Gy to the planning target volume I, and 50-56 Gy to the clinically negative neck. For T3-4 disease,the prescription dose was 74-78 Gy to GTVnx. The local control rate(LC),overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were estimated by Kaplan-Meier method. Results The 3-year LC, OS, DFS and DMFS of the whole group were 93.2% ,93.5% ,72.6% and 74.4% ,respectively. T stage was a significant predictor of LC and OS. For patients with T1-2 and T3-4 disease,the LC was 100% and 86.9% (P=0.007) and OS was 95.5% and 91.3% (P=0.030), respectively. N stage was a significant predictor of OS, DFS and DMFS(P=0.03,0.004 and 0.0004,respectively). The grade Ⅰ+ Ⅱ and Ⅲ acute toxieities of parotid were 96.6% and 1.4%. The rate of grade Ⅱ xerostomia at 3-month, 6-month, 1-year and 2-year after radiotherapy were 43.0%, 12.0% ,4.9% and 3.2%. Conclusions The treatment results are promising according to our target definition and dose prescription protocol for nasopharyngeal carcinoma.