Second Primary Malignancies after Definitive Radiotherapy for Nasopharyngeal Carcinoma

鼻咽癌患者接受放射治療後產生第二原發癌症之長期追蹤報告

10.6316/TRO/201421(4)257

劉怡君(Yi-Chun Liu)；林伯儒(Po-Ju Lin)；林進清(Jin-Ching Lin)

鼻咽癌 ； 第二原發癌症 ； 放射線治療 ； Nasopharyngeal carcinoma ； Second primary malignancy ； Radiation therapy

放射治療與腫瘤學

21卷4期（2014 / 12 / 01）

257 - 265

英文

目的：分析於本院接受根治性放療之鼻咽癌病人，治療後產生第二原發性癌症的特徵以及存活。材料與方法：自1984年1月至2010年8月，有2208例病人經病理切片確診為鼻咽癌且於本科接受根治性放射治療（±化療），其中共有58例於治療後產生第二原發癌症。我們仔細瀏覽病歷紀錄、放療紀錄、影像資料，分析其臨床特色、治療經過、存活狀況。結果：第二原發癌症粗發生率為2.6%，累積發生率於五年、十年、十五年、二十年、二十五年分別為1.5%、4.7%、5.6%、9.2%、14%。頭頸癌為最常見的第二原發癌症（29.3%），其次為肺癌（19.0%）、大腸直腸（12.1%）及女性乳癌（12.1%）。存活率中位數為3年（範圍1月-10.9年）。所有病人的兩年、五年、十年存活分別為52.3%、29.5%、11.8%。乳癌以及大腸直腸癌患者相較於頭頸癌、肺癌、以及肝膽腸胃癌患者有較好的預後（五年整體存活率56.3% vs. 15.8%,p=0.0029）結論：鼻咽癌病患放療後發生第二原發癌症之累積盛行率隨著追蹤時間增加而增加。好發處以頭頸部癌症最常見；治療後以大腸直腸以及女性乳癌存活率最好。

Purpose: To investigate the clinical features and survival outcomes of second primary malignancies (SPM) in nasopharyngeal carcinoma (NPC) after definitive radiotherapy. Materials and Methods: From January 1984 to August 2010, a total of 2208 patients with pathologically-proven NPC who received curative radiotherapy with or without chemotherapy were screened for the occurrence of SPM. Fifty-eight patients were eligible for the final analysis. We reviewed hospital charts, radiotherapy records and diagnostic imaging studies thoroughly and analyzed the clinical characteristics, treatment courses, and survival outcomes. Results: The overall incidence of SPM in this study was 2.6% (58/2208). The cumulative incidences at 5 years, 10 years, 15 years, 20 years, and 25 years were 1.5%, 4.7%, 5.6%, 9.2%, and 14%, respectively. Head and neck (H&N) was the most common site of SPM (29.3%), followed by the lung (19.0%), colon/rectum (12.1%) and female breast (12.1%). The median survival after diagnosis of SPM was 3 years (range, 1 month-10.9 years). The 2-year, 5-year, and 10-year survival rates after SPM diagnosis were 52.3%, 29.5%, and 11.8%, respectively. Patients with SPM arising from the breast/ colon/rectum had better survival than those with SPM arising from the H&N/lung/liverpancreas- stomach (5-year OS rates, 56.3% vs. 15.8%, p=0.0029). Conclusion: The cumulative incidence of SPM in NPC patients after definitive radiotherapy increased over time. Head and neck cancer is the most common site of SPM. Patients with SPM of colon/rectum and female breast had the best survival outcome.