【摘 要】
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Objective: The optimal model of total dose and fraction size for locally recurrent nasopharyngeal carcinoma (NPC) with intensity-modulated radiotherapy (IMRT) remains unclear.We designed a randomised
【机 构】
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Department of Radiation Ontology, Sun Yat-sen University Cancer Centre;State Key Laboratory of Oncol
【出 处】
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第九届泛珠江区域放射肿瘤学学术大会暨肿瘤放射治疗多中心协作研讨会、重庆市医学会放射肿瘤治疗学专业委员会2014年会
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Objective: The optimal model of total dose and fraction size for locally recurrent nasopharyngeal carcinoma (NPC) with intensity-modulated radiotherapy (IMRT) remains unclear.We designed a randomised phase 2, clinical trial to investigate the efficacy of two different models, aimed at determining an optimal model.Methods: Between January 2003 and December 2007, 117 patients with locally recurrent,non-metastatic NPC were randomized to two different models of total dose and firaction size: group A, 60 Gy/27f (59 patients);and group B, 68 Gy/34f (58 patients).Both received five daily fractions per week.All patients received IMRT alone.Results: Median follow-up was 25.0 months.Five-year overall survival in group A was higher than that in group B at 44.2% vs 30.3% (P=0.06), and the local failure-free survival in group A was slightly lower than that in group B at 63.7% vs 71.0%, (P=0.41).Severe late complications were the main cause of death.The incidences of mucosal necrosis and massive haemorrhage in group B were significantly higher than those in group A, at 50.8% vs 28.8% (P=0.02) and 31.0% vs 18.6% (P=0.12), respectively.Tumour volume (P<0.01) and model of total dose and fraction size (P=0.03) were significant factors for mucosal necrosis and massive haemorrhage.Conclusion: Appropriately decreasing total dose and increasing fraction size can achieve local control similar to that achieved with a higher dose after IMRT;furthermore, it can improve overall survival by significantly reducing the incidence of severe late complications including mucosal necrosis and massive haemorrhage.
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