Ⅲ、Ⅳ期鼻咽癌综合治疗临床分析  

Clinical Analysis of Combined Therapy For Stage Ⅲ 、Ⅳ Nasopharyngeal Carcinoma

作　　者：康静波[1] 聂青[1] 李进让[1] 张丽萍[1] 李方明[1] 杨平[1] 郭红光[1] 

机构地区：[1]中国人民解放军海军总医院,100037

出　　处：《实用癌症杂志》2005年第2期171-173,共3页The Practical Journal of Cancer

摘　　要：目的探讨Ⅲ、Ⅳ期鼻咽癌的综合治疗方法。方法自1995年1月至1999年12月,收治Ⅲ、Ⅳ期鼻咽癌患者86例,鳞癌82例,未分化癌4例。采用1992年全国鼻咽癌福州会议制定的鼻咽癌分期方案进行分期:Ⅲ期(T2N2M026例,T3N1～2M021例)47例,Ⅳ期(T3N3M023例,T4N1～3M016例)39例。先采用面颈联合野放疗36～42Gy,再面颈分野,避开脊髓,鼻咽部继续放疗至66～76Gy;对其中经鼻咽CT检查证实有肿瘤残存50例补充后装近距离放疗2～4次,近距离放疗总剂量为12～18Gy;残存病灶位于颅底及海绵窦者8例,采用立体定向伽玛射线头部治疗系统(伽玛刀)补充放射剂量7～9Gy。放疗结束后2周,开始化疗,化疗药物为卡铂、5氟脲嘧啶、甲酰四氢叶酸钙,共化疗1～3个疗程。结果按3个月统计缓解率(CR+PR)为86.1%。以放疗开始日计算生存期,肿瘤3年、5年局部控制率分别为62.8%、39.5%,3年、5年生存率分别为67.4%、43.0%。随访期内未见严重并发症。结论对Ⅲ、Ⅳ期鼻咽癌采用以放疗为主的综合治疗,疗效较满意。采用近距离放疗或立体定向放射外科技术(伽玛刀)补充治疗,只要设计合理,就不会增高严重并发症的发生率。Objective To study the effect of combined therapy for stage Ⅲ、Ⅳ nasopharyngeal carcinoma(NPC).Methods From January,1995 to December,1999,86 patients with stage Ⅲ、Ⅳ NPC,including 82 cases of squamous cancer and 4 cases of undifferentiated cancer,were treated.Firstly,the patients received radical external radiotherapy(66～76Gy).50 cases with residual lesions documented by CT were treated by brachytherapy with a total dose of 12～18 Gy.8 cases with their cranial base and cavernous sinus infiltrated were treated by γ-knife with a dose of 7～9 Gy.Chemotherapy was taken for 1～3 courses 2 weeks after radiotherapy.Results The 3-month CR+PR was 86.1%.The 3-year and 5-year local control rates were 62.8% and 39.5%.The 3-year and 5-year survival rates were 67.4% and 43.0%.No severe complication were observed.Conclusion Radiotherapy-based combined therapy has a satisfactory effect for the treatment of stage Ⅲ、Ⅳ stage NPC.The additional brachytherapy and γ-knife will not increase the risk of complications.

关 键 词：Ⅳ期鼻咽癌 临床分析 近距离放疗 甲酰四氢叶酸钙 严重并发症 综合治疗方法 立体定向放射 1999年 1995年 鼻咽癌患者 1992年 面颈联合野 5氟脲嘧啶 局部控制率 5年生存率 未分化癌 分期方案 面颈分野 肿瘤残存 CT检查 放射剂量 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]