鼻咽癌放疗后局部残留的治疗选择及预后现状
Treatment Options and Current Prognosis for Local Residual Nasopharyngeal Carcinoma after Radiotherapy
DOI: 10.12677/acm.2025.152382, PDF,   
作者: 陈 森, 李俊慧, 杨 佳, 黄志凤, 郭 甜, 张碧琳:西安医学院研究生院,陕西 西安;刘秋芳*:陕西省肿瘤医院放疗科,陕西 西安
关键词: 鼻咽癌放射治疗局部残留预后Nasopharyngeal Carcinoma Radiotherapy Local Residual Prognosis
摘要: 鼻咽癌(nasopharyngeal carcinoma, NPC)是一种起源于鼻咽黏膜上皮细胞的恶性肿瘤,通常被认为与EB病毒感染、遗传易感性及环境因素等相关。由于鼻咽解剖位置特殊,放射治疗(简称放疗)已成为当前NPC治疗的核心。然而,放疗完成后,仍有部分NPC患者存在肿瘤局部残留。目前对于局部残留的治疗时机、治疗方式以及残留对预后的影响尚存在诸多争议。本文旨在综述NPC放疗后局部残留的当前治疗选择及其预后现状。
Abstract: Nasopharyngeal carcinoma (NPC) is a malignant tumor originating from the epithelial cells of the nasopharyngeal mucosa and is commonly associated with Epstein-Barr virus (EBV) infection, genetic susceptibility, and environmental factors. Due to the unique anatomical location of the nasopharynx, radiotherapy (RT) has become the cornerstone of NPC treatment. However, even after completing RT, a subset of NPC patients still exhibit residual local tumors. Currently, there is significant controversy surrounding the timing of treatment, therapeutic approaches, and the impact of residual tumors on prognosis. This article aims to review the current treatment options for local residual NPC after radiotherapy and their prognostic implications.
文章引用:陈森, 刘秋芳, 李俊慧, 杨佳, 黄志凤, 郭甜, 张碧琳. 鼻咽癌放疗后局部残留的治疗选择及预后现状[J]. 临床医学进展, 2025, 15(2): 581-589. https://doi.org/10.12677/acm.2025.152382

参考文献

[1] Xu, T., Zhou, X., Shen, C. and Hu, C. (2018) Suggestions for Surveillance and Radiation Strategy in Nasopharyngeal Carcinoma Treated with IMRT: Based on Hazard-Rate and Patterns of Recurrence. Oral Oncology, 76, 61-67. [Google Scholar] [CrossRef] [PubMed]
[2] Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R.L., Soerjomataram, I., et al. (2024) Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 74, 229-263. [Google Scholar] [CrossRef] [PubMed]
[3] Au, K.H., Ngan, R.K.C., Ng, A.W.Y., Poon, D.M.C., Ng, W.T., Yuen, K.T., et al. (2018) Treatment Outcomes of Nasopharyngeal Carcinoma in Modern Era after Intensity Modulated Radiotherapy (IMRT) in Hong Kong: A Report of 3328 Patients (HKNPCSG 1301 Study). Oral Oncology, 77, 16-21. [Google Scholar] [CrossRef] [PubMed]
[4] Xiao, X., Zou, S., Chen, Y., Guo, R., Tang, L., Sun, Y., et al. (2024) Patterns and Prognosis of Local Recurrence of Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy. Journal of Cancer, 15, 456-465. [Google Scholar] [CrossRef] [PubMed]
[5] Li, C. and Duan, J. (2021) Effect of High-Quality Nursing Intervention on Psychological Emotion, Life Quality and Nursing Satisfaction of Patients with Nasopharyngeal Carcinoma Undergoing Radiotherapy. American Journal of Translational Research, 13, 4928-4938.
[6] Zhou, X., Zhu, J., Zhou, C., Wang, W., Ding, W., Chen, M., et al. (2023) Failure Patterns of Locoregional Recurrence after Reducing Target Volumes in Patients with Nasopharyngeal Carcinoma Receiving Adaptive Replanning during Intensity-Modulated Radiotherapy: A Single-Center Experience in China. Radiation Oncology, 18, Article No. 190. [Google Scholar] [CrossRef] [PubMed]
[7] Huang, Y., Zhou, J., Zhan, Z., Ke, L., Xia, W., Cao, X., et al. (2023) Tumor Residue in Patients with Stage II-IVA Nasopharyngeal Carcinoma Who Received Intensity-Modulated Radiation Therapy: Development and Validation of a Prediction Nomogram Integrating Postradiotherapy Plasma Epstein-Barr Virus Deoxyribonucleic Acid, Clinical Stage, and Radiotherapy Dose. BMC Cancer, 23, Article No. 410. [Google Scholar] [CrossRef] [PubMed]
[8] Tian, Y., Huang, W., Zeng, L., Bai, L., Han, F. and Lan, Y. (2022) The Failure Patterns of Nasopharygeal Carcinoma after Intensity-Modulated Radiotherapy and Implications for Surveillance. Cancer Management and Research, 14, 2813-2823. [Google Scholar] [CrossRef] [PubMed]
[9] Tang, L., Guan, Z. and Xu, M. (2022) The Role of Circulating Tumor Cells in the Prognosis of Local Recurrence and Local Residual Nasopharyngeal Carcinoma Undergoing Endoscopic Resection. Journal of Oncology, 2022, Article ID: 1453792. [Google Scholar] [CrossRef] [PubMed]
[10] Stoker, S.D., van Diessen, J.N.A., de Boer, J.P., Karakullukcu, B., Leemans, C.R. and Tan, I.B. (2013) Current Treatment Options for Local Residual Nasopharyngeal Carcinoma. Current Treatment Options in Oncology, 14, 475-491. [Google Scholar] [CrossRef] [PubMed]
[11] Poh, S.S., Soong, Y.L., Sommat, K., Lim, C.M., Fong, K.W., Tan, T.W., et al. (2021) Retreatment in Locally Recurrent Nasopharyngeal Carcinoma: Current Status and Perspectives. Cancer Communications, 41, 361-370. [Google Scholar] [CrossRef] [PubMed]
[12] Weng, J., Wei, J., Si, J., Qin, Y., Li, M., Liu, F., et al. (2017) Clinical Outcomes of Residual or Recurrent Nasopharyngeal Carcinoma Treated with Endoscopic Nasopharyngectomy Plus Chemoradiotherapy or with Chemoradiotherapy Alone: A Retrospective Study. PeerJ, 5, e3912. [Google Scholar] [CrossRef] [PubMed]
[13] Lv, J., Zhou, G., Li, J., Tang, L., Mao, Y., Lin, A., et al. (2017) Magnetic Resonance Imaging-Detected Tumor Residue after Intensity-Modulated Radiation Therapy and Its Association with Post-Radiation Plasma Epstein-Barr Virus Deoxyribonucleic Acid in Nasopharyngeal Carcinoma. Journal of Cancer, 8, 861-869. [Google Scholar] [CrossRef] [PubMed]
[14] Zhou, P., Zhou, J., Lian, C., Yu, Y., Zhou, R., Lin, Q., et al. (2023) Residual Plasma Epstein-Barr Virus DNA after Intensity-Modulated Radiation Therapy Is Associated with Poor Outcomes in Nasopharyngeal Carcinoma. Future Oncology, 19, 2227-2235. [Google Scholar] [CrossRef] [PubMed]
[15] Li, W., Wu, H., Lv, S., Hu, X., Liang, H., Liu, G., et al. (2021) Assessment of Survival Model Performance Following Inclusion of Epstein-Barr Virus DNA Status in Conventional TNM Staging Groups in Epstein-Barr Virus-Related Nasopharyngeal Carcinoma. JAMA Network Open, 4, e2124721. [Google Scholar] [CrossRef] [PubMed]
[16] Kwong, D.L.W., Nicholls, J., Wei, W.I., Chua, D.T.T., Sham, J.S.T., Yuen, P.W., et al. (1999) The Time Course of Histologic Remission after Treatment of Patients with Nasopharyngeal Carcinoma. Cancer, 85, 1446-1453. [Google Scholar] [CrossRef
[17] Li, W., Zhang, Y., Liu, X., Tang, L., Tian, L., Guo, R., et al. (2017) Delayed Clinical Complete Response to Intensity-Modulated Radiotherapy in Nasopharyngeal Carcinoma. Oral Oncology, 75, 120-126. [Google Scholar] [CrossRef] [PubMed]
[18] Sham, J.S.T., Wei, W.I., Kwan, W.H., Chan, C.W., Kwong, W.K. and Choy, D. (1990) Nasopharyngeal Carcinoma. Pattern of Tumor Regression after Radiotherapy. Cancer, 65, 216-220. [Google Scholar] [CrossRef
[19] Zhang, N., Liang, S., Deng, Y., Lu, R., Chen, H., Zhao, H., et al. (2014) Primary Tumor Regression Speed after Radiotherapy and Its Prognostic Significance in Nasopharyngeal Carcinoma: A Retrospective Study. BMC Cancer, 14, Article No. 136. [Google Scholar] [CrossRef] [PubMed]
[20] Jin, T., Liu, N., Jin, Q., Hua, Y. and Chen, X. (2022) Radiation Dose Escalation for Locally Advanced Nasopharyngeal Carcinoma Patients with Local and/or Regional Residual Lesions after Standard Chemoradiotherapy: A Non-Randomized, Observational Study. Radiation Oncology, 17, Article No. 176. [Google Scholar] [CrossRef] [PubMed]
[21] Murakami, N., Cheng, G., Yoshimoto, S. and Itami, J. (2020) Image-Guided Interstitial Brachytherapy Boost for Nasopharyngeal Carcinoma: Technical Aspects. Journal of Contemporary Brachytherapy, 12, 294-302. [Google Scholar] [CrossRef] [PubMed]
[22] Guinot, J.L., Moya, A., Santos, M.A., Peña, M., Quiles, B., Sanchez-Relucio, J.C., et al. (2020) Should High-Dose-Rate Brachytherapy Boost Be Used in Early Nasopharyngeal Carcinomas? Reports of Practical Oncology & Radiotherapy, 25, 479-483. [Google Scholar] [CrossRef] [PubMed]
[23] Leung, T., Tung, S.Y., Sze, W., Sze, W., Wong, V.Y.W. and O, S. (2000) Salvage Brachytherapy for Patients with Locally Persistent Nasopharyngeal Carcinoma. International Journal of Radiation Oncology Biology Physics, 47, 405-412. [Google Scholar] [CrossRef] [PubMed]
[24] Law, S.C.K., Lam, W., Ng, M., Au, S., Mak, W. and Lau, W. (2002) Reirradiation of Nasopharyngeal Carcinoma with Intracavitary Mold Brachytherapy: An Effective Means of Local Salvage. International Journal of Radiation Oncology Biology Physics, 54, 1095-1113. [Google Scholar] [CrossRef] [PubMed]
[25] Teo, P., Leung, S.F., Choi, P., Lee, W.Y. and Johnson, P.J. (1994) After Loading Radiotherapy for Local Persistence of Nasopharyngeal Carcinoma. The British Journal of Radiology, 67, 181-185. [Google Scholar] [CrossRef] [PubMed]
[26] Kwong, D.L.W., Wei, W.I., Cheng, A.C.K., Choy, D.T.K., Lo, A.T.C., Wu, P.M., et al. (2001) Long Term Results of Radioactive Gold Grain Implantation for the Treatment of Persistent and Recurrent Nasopharyngeal Carcinoma. Cancer, 91, 1105-1113. [Google Scholar] [CrossRef
[27] Ren, Y.F., Cao, X.P., Xu, J., Ye, W.J., Gao, Y.H., Teh, B.S., et al. (2013) 3D-Image-Guided High-Dose-Rate Intracavitary Brachytherapy for Salvage Treatment of Locally Persistent Nasopharyngeal Carcinoma. Radiation Oncology, 8, Article No. 165. [Google Scholar] [CrossRef] [PubMed]
[28] Zhang, X., Wu, N., Zhao, Z., Han, D., He, M., Yang, W., et al. (2019) Fibre-Optic Endoscope-Guided Three-Dimensional High-Dose-Rate Interstitial Brachytherapy for Residual Nasopharyngeal Carcinoma after Conventional External Beam Radiotherapy. Journal of Contemporary Brachytherapy, 11, 243-249. [Google Scholar] [CrossRef] [PubMed]
[29] Wan, X., Jiang, R., Xie, F., Qi, Z., Li, A., Ye, W., et al. (2014) Endoscope-Guided Interstitial Intensity-Modulated Brachytherapy and Intracavitary Brachytherapy as Boost Radiation for Primary Early T Stage Nasopharyngeal Carcinoma. PLOS ONE, 9, e90048. [Google Scholar] [CrossRef] [PubMed]
[30] Yue, Q., Zhang, M., Chen, Y., Zheng, D., Chen, Y. and Feng, M. (2018) Establishment of Prognostic Factors in Recurrent Nasopharyngeal Carcinoma Patients Who Received Salvage Intensity-Modulated Radiotherapy: A Meta-Analysis. Oral Oncology, 81, 81-88. [Google Scholar] [CrossRef] [PubMed]
[31] Lee, C., Lee, J., Huang, W., Juan, C., Jen, Y. and Lin, L. (2021) Image-Based Diagnosis of Residual or Recurrent Nasopharyngeal Carcinoma May Be a Phantom Tumor Phenomenon. Medicine, 100, e24555. [Google Scholar] [CrossRef] [PubMed]
[32] Ma, Z., Umezawa, R., Yamamoto, T., Ishikawa, Y., Takahashi, N., Takeda, K., et al. (2021) IMRT Improves Local Control in Patients with Nasopharyngeal Carcinoma Compared with Conventional Radiotherapy: Propensity Score-Matched Analysis. Japanese Journal of Clinical Oncology, 51, 1444-1451. [Google Scholar] [CrossRef] [PubMed]
[33] Du, T., Xiao, J., Qiu, Z. and Wu, K. (2019) The Effectiveness of Intensity-Modulated Radiation Therapy versus 2D-RT for the Treatment of Nasopharyngeal Carcinoma: A Systematic Review and Meta-analysis. PLOS ONE, 14, e0219611. [Google Scholar] [CrossRef] [PubMed]
[34] Liang, S., Zhang, N., Chen, D., Yang, X., Chen, B., Zhao, H., et al. (2019) Prognostic Value of Gross Tumor Regression and Plasma Epstein Barr Virus DNA Levels at the End of Intensity-Modulated Radiation Therapy in Patients with Nasopharyngeal Carcinoma. Radiotherapy and Oncology, 132, 223-229. [Google Scholar] [CrossRef] [PubMed]
[35] Fei, Z., Xu, T., Qiu, X., Li, M., Chen, T., Li, L., et al. (2021) Significance of Boost Dose for T4 Nasopharyngeal Carcinoma with Residual Primary Lesion after Intensity-Modulated Radiotherapy. Journal of Cancer Research and Clinical Oncology, 147, 2047-2055. [Google Scholar] [CrossRef] [PubMed]
[36] Lu, T., Mai, W., Teh, B.S., Zhao, C., Han, F., Huang, Y., et al. (2004) Initial Experience Using Intensity-Modulated Radiotherapy for Recurrent Nasopharyngeal Carcinoma. International Journal of Radiation Oncology Biology Physics, 58, 682-687. [Google Scholar] [CrossRef] [PubMed]
[37] Chua, D.T.T., Sham, J.S.T., Leung, L.H.T. and Au, G.K.H. (2005) Reirradiation of Nasopharyngeal Carcinoma with Intensity-Modulated Radiotherapy. Radiotherapy and Oncology, 77, 290-294. [Google Scholar] [CrossRef] [PubMed]
[38] Karam, I., Huang, S.H., McNiven, A., Su, J., Xu, W., Waldron, J., et al. (2015) Outcomes after Reirradiation for Recurrent Nasopharyngeal Carcinoma: North American Experience. Head & Neck, 38, E1102-E1109. [Google Scholar] [CrossRef] [PubMed]
[39] Chen, Y., Ismaila, N., Chua, M.L.K., Colevas, A.D., Haddad, R., Huang, S.H., et al. (2021) Chemotherapy in Combination with Radiotherapy for Definitive-Intent Treatment of Stage II-IVA Nasopharyngeal Carcinoma: CSCO and ASCO Guideline. Journal of Clinical Oncology, 39, 840-859. [Google Scholar] [CrossRef] [PubMed]
[40] Xiao, J. and Zhen, X. (2010) Stereotactic Radiotherapy—An Approach to Improve Local Control of Nasopharyngeal Carcinoma. Chinese Journal of Cancer, 29, 123-125. [Google Scholar] [CrossRef] [PubMed]
[41] 肖建平, 徐国镇. 立体定向放射治疗: 提高鼻咽癌局部控制的有效方法[J]. 癌症, 2010, 29(2): 129-131.
[42] Liu, F., Xiao, J.P., Xu, Y.J., et al. (2012) Fractionated Stereotactic Radiotherapy with Vagina Carotica Protection Technique for Local Residual Nasopharyngeal Carcinoma after Primary Radiotherapy. Chinese Medical Journal (England), 125, 2525-2529.
[43] Liu, F., Xiao, J., Xu, G., Gao, L., Xu, Y., Zhang, Y., et al. (2013) Fractionated Stereotactic Radiotherapy for 136 Patients with Locally Residual Nasopharyngeal Carcinoma. Radiation Oncology, 8, Article No. 157. [Google Scholar] [CrossRef] [PubMed]
[44] Chua, D.T., Wu, S., Lee, V. and Tsang, J. (2009) Comparison of Single versus Fractionated Dose of Stereotactic Radiotherapy for Salvaging Local Failures of Nasopharyngeal Carcinoma: A Matched-Cohort Analysis. Head & Neck Oncology, 1, Article No. 13. [Google Scholar] [CrossRef] [PubMed]
[45] Chitapanarux, I., Kittichest, R., Tungkasamit, T., Asakit, T., Chomprasert, K., Chakrabandhu, S., et al. (2021) Two-Year Outcome of Concurrent Chemoradiation with Carboplatin with or without Adjuvant Carboplatin/Fluorouracil in Nasopharyngeal Cancer: A Multicenter Randomized Trial. Current Problems in Cancer, 45, Article ID: 100620. [Google Scholar] [CrossRef] [PubMed]
[46] Chen, Y., Liu, X., Zhou, Q., Yang, K., Jin, F., Zhu, X., et al. (2021) Metronomic Capecitabine as Adjuvant Therapy in Locoregionally Advanced Nasopharyngeal Carcinoma: A Multicentre, Open-Label, Parallel-Group, Randomised, Controlled, Phase 3 Trial. The Lancet, 398, 303-313. [Google Scholar] [CrossRef] [PubMed]
[47] Cao, X., Huang, H., Liang, C., Lin, Z., Zhou, J., Chen, X., et al. (2024) Toripalimab plus Capecitabine in the Treatment of Patients with Residual Nasopharyngeal Carcinoma: A Single-Arm Phase 2 Trial. Nature Communications, 15, Article No. 949. [Google Scholar] [CrossRef] [PubMed]
[48] Mai, H., Chen, Q., Chen, D., Hu, C., Yang, K., Wen, J., et al. (2021) Toripalimab or Placebo plus Chemotherapy as First-Line Treatment in Advanced Nasopharyngeal Carcinoma: A Multicenter Randomized Phase 3 Trial. Nature Medicine, 27, 1536-1543. [Google Scholar] [CrossRef] [PubMed]
[49] Ruan, X., Liang, J., Pan, Y., Cai, R., Zhang, R.J., He, Z., et al. (2021) Apatinib for the Treatment of Metastatic or Locoregionally Recurrent Nasopharyngeal Carcinoma after Failure of Chemotherapy: A Multicenter, Single‐Arm, Prospective Phase 2 Study. Cancer, 127, 3163-3171. [Google Scholar] [CrossRef] [PubMed]
[50] 张力. 鼻咽癌的综合治疗进展[J]. 肿瘤防治研究, 2019, 46(8): 667-671.
[51] Jiang, S., Han, L., Liang, L. and Long, L. (2022) Development and Validation of an MRI-Based Radiomic Model for Predicting Overall Survival in Nasopharyngeal Carcinoma Patients with Local Residual Tumors after Intensity-Modulated Radiotherapy. BMC Medical Imaging, 22, Article No. 174. [Google Scholar] [CrossRef] [PubMed]
[52] He, Y., Zhou, Q., Shen, L., Zhao, Y., Lei, M., Wei, R., et al. (2015) A Retrospective Study of the Prognostic Value of MRI-Derived Residual Tumors at the End of Intensity-Modulated Radiotherapy in 358 Patients with Locally-Advanced Nasopharyngeal Carcinoma. Radiation Oncology, 10, Article No. 89. [Google Scholar] [CrossRef] [PubMed]
[53] Xu, M., Liu, C., Mi, J.L. and Wang, R.S. (2020) A Nomogram for the Prognosis of Nasopharyngeal Carcinoma with MR Imaging-Detected Tumor Residue at the End of Intensity-Modulated Radiotherapy. Cancer Management and Research, 12, 3835-3844. [Google Scholar] [CrossRef] [PubMed]