早期鼻咽癌单纯外照射与加近距离治疗的远期结果比较  

Randomized trial on external radiation therapy alone versus external radiation therapy followed by brachytherapy in early stage nasopharyngeal carcinoma with a long term result

作　　者：高黎[1] 袁智勇[1] 徐国镇[1] 李素艳[1] 肖光莉[1] 蔡伟明[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院放射治疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2004年第4期247-251,共5页Chinese Journal of Radiation Oncology

摘　　要：目的　随机比较单纯常规外照射与外照射加近距离治疗对早期鼻咽癌原发灶的局部控制疗效和并发症。方法　对 12 6例初治的、福州分期为T1期和部分T2期 (口咽、颈动脉鞘、椎前软组织受侵者除外 )鼻咽癌病例进行前瞻性分组。单纯常规外照射组 (RT) 6 1例 ,外照射加192 Ir高剂量率近距离治疗组 (RB) 6 5例。 2 6例T1期在疗前经抽签随机接受单纯外照射 6 6～ 70Gy或外照射 5 6Gy加近距离治疗 10～ 16Gy,1～ 2次 (中位剂量 16Gy) ;10 0例T2期先采用常规外照射至 5 0Gy后 ,行CT或MRI检查 ,对咽旁间隙消退满意的病例入组随机接受单纯外照射 (中位剂量 72Gy)或外照射 (中位剂量 6 6Gy)加近距离治疗 8～ 2 4Gy ,1～ 3次 (中位剂量 16Gy)。近距离治疗在外照射结束后 1周进行 ,剂量参考点距施源器中心轴的距离为 7～ 12mm ,单次近距离照射剂量为 5～ 8Gy/周。结果　外照射结束时RT组鼻咽病灶残留 6例 ,消退 5 5例 ;RB组残留 13例 ,消退 4 6例 ,未评价 6例。RT组鼻咽部失败 8例 ,RB组鼻咽部失败 7例 (包括单独颅底失败 2例 )。 5年鼻咽 (颅底 )局部控制率RT组为 86 % ,RB组为 88%。 5年总生存率RT组为 83% ,RB组为 84 % (P =0 .84 )。放射性脑病RT组为 10例 ( 1级4例 ,2级 6例 ) ,RB组为 7例 ( 1级 4例 ,2级 3例 )。?Objective To compare local control and toxicity in patients treated with external beam radiotherapy followed by intracavitary brachytherapy (BT) versus external beam radiotherapy alone (RT) for locally early stage nasopharyngeal carcinoma (NPC). Methods From 1990 to 1997, 126 NPC patients staged T1 and T2 by 1992 Fuzhou Staging System (oropharynx, carotid sheath and soft tissue around cervical vertebral involvement excluded) were randomized into RT alone and RT followed BT groups. The two groups were comparable in age, gender, stage and pathology. The median follow-up was 112 months. T1 patients were randomized before the treatment into RT alone group of 66-70?Gy and RT plus BT with the dose of 56?Gy plus 10-16?Gy BT boost to the nasopharynx. For T2 patients, if MRI or CT showed no residual lesion in parapharyngeal space after 50?Gy, they were randomized into RT alone (median dose: 72?Gy) or RT of 66?Gy followed by 8-24?Gy BT boost (1-3 fractions over 1-3 weeks). Results In RT group, 8 patients (13.1%) failed in primary site during the follow-up period, 7 (11%) in BT group. The 5-year local control rates was 86% for RT group and 88% for BT group (P=0.47). The 5-year overall survival rates were 83% and 84% (P=0.84), respectively. Ten patients (18%) in RT group (4 of grade Ⅰ, 6 of grade Ⅱ) and 7 patients (11%) in BT group (4 of grade Ⅰ, 3 of grade Ⅱ, P=0.31) developed radiation induced encephalopathy. The incidence of trismus was much lower in BT group than in RT group (26% versus 10%, P=0.02). No soft palate perforation or sphenoid necrosis were observed. Conclusion Compared to conventional external beam radiaotherapy, planned irradiation plus intracavitary brachytherapy not only can achieve similar local control and survival rates for locally early stage nasopharyngeal carcinoma, but also decrease irradiation dose and the trismus incidence.

关 键 词：早期鼻咽癌 单纯外照射治疗 加近距离治疗 放射性脑病 预后 放射疗法 

分 类 号：R739.63[医药卫生—肿瘤]