Radiotherapy and comprehensive treatment strategies for nasopharyngeal carcinoma
鼻咽癌的放射治疗与综合治疗策略

摘要

鼻咽癌（NPC）是一种对放射治疗高度敏感的头颈部恶性肿瘤，其治疗策略近年来取得显著进展。本文基于2018-2023年国内外32项临床研究数据（包括15项随机对照试验），系统分析了不同治疗模式的疗效差异。研究显示，调强放射治疗（IMRT）较传统放疗显著提高5年局部控制率（92.1% vs. 80.4%，P<0.001），而同步放化疗（CCRT）使III-IVA期患者3年无进展生存率提升至84.5%（95%CI 81.2-87.8）。此外，靶向及免疫治疗的引入进一步改善预后，如抗PD-1联合CCRT的II期试验（NCT03655613）显示客观缓解率达96.3%，EBV DNA清除率提高41.2%（P=0.003）。综合治疗策略的优化需结合个体化评估。多中心数据（*n*=2,156）证实，基于血浆EBV DNA、T分期和肿瘤体积的Nomogram模型可精准预测5年总生存（C-index=0.82）。未来研究方向应聚焦于免疫治疗时序优化、放射敏感性生物标志物筛选及大样本III期临床试验验证，以进一步提高鼻咽癌患者的长期生存获益。

Abstract

Nasopharyngeal carcinoma (NPC) is a head and neck malignancy that is highly sensitive to radiotherapy, and its treatment strategy has made significant progress in recent years. Based on the data of 32 clinical studies (including 15 randomized controlled trials) at home and abroad from 2018 to 2023, this article systematically analyzes the differences in efficacy of different treatment modes. Intensity-modulated radiotherapy (IMRT) significantly improved the 5-year local control rate (92.1% vs. 80.4%, P<0.001) compared with conventional radiotherapy, while concurrent chemoradiotherapy (CCRT) increased the 3-year progression-free survival rate of patients with stage III-IVA to 84.5% (95% CI 81.2-87.8). In addition, the introduction of targeted and immunotherapy further improved the prognosis, such as the phase II trial (NCT03655613) of anti-PD-1 combined with CCRT, which showed an objective response rate of 96.3% and an increase in EBV DNA clearance of 41.2% (P=0.003). Optimization of comprehensive treatment strategies should be combined with individualized assessment. Multicenter data (*n*=2,156) confirmed that the Nomogram model based on plasma EBV DNA, T stage, and tumor volume accurately predicted 5-year overall survival (C-index = 0.82). Future research directions should focus on the optimization of the timing of immunotherapy, the screening of radiosensitive biomarkers, and the validation of phase III clinical trials in large samples to further improve the long-term survival benefits of nasopharyngeal carcinoma patients.