鼻咽癌单纯常规外照射放疗疗效的分析  

Retrospective analysis of 934 nasopharyngeal carcinoma patients treated with conventional external beam radiotherapy alone

作　　者：卢泰祥[1] 赵充[1] 吴少雄[1] 罗伟[1] 陈勇[1] 谢方云[1] 陈明[1] 曾祥发[1] 胡伟汉[1] 曹新平[1] 夏云飞[1] 刘秀芳[1] 崔念基[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心放射治疗科,广州510060

出　　处：《中华肿瘤杂志》2005年第10期620-622,共3页Chinese Journal of Oncology

基　　金：广东省鼻咽癌诊治重点实验室资助项目(99-B-07703-S);广东省科委医学联合攻关项目(1998-278)

摘　　要：目的分析934例初治鼻咽癌单纯常规外照射放疗的临床效果,探讨提高疗效的临床因素.方法对我院1999年全年934例初治鼻咽癌单纯常规外照射放疗的疗效进行回顾性分析.全部病例均根据CT和MRI对照射靶区进行个体化设计,按规范化要求制定治疗计划.采用低熔点铅挡块、面颈联合野等中心照射技术.鼻咽根治剂量68～70 Gy/7周,颈淋巴结阳性者颈部根治剂量60～70 Gy/6～7周,阴性者给予预防剂量50 Gy/5周.结果全组病例1,2,3,4年总生存率分别为89.5%、81.9%、78.1%和75.7%;无瘤生存率分别为80.8%、73.1%、68.5%和65.1%;无转移生存率分别为84.0%、77.2%、74.4%和72.0%;无复发生存率分别为95.5%、92.7%、90.3%和87.3%.全组病例放疗结束总残留率为14.6%,4年复发率为7.2%,远处转移率为9.2%,放疗后的总失败率为30.9%.中位复发时间为放疗后19.3个月,中位转移时间为放疗后12.8个月.结论采用CT和MRI进行照射靶区的个体化设计,改进照射技术,缩短总疗程时间,提高照射剂量,加强放疗全过程的质量控制与质量保证,有助于提高鼻咽癌常规放疗的疗效.Objective To analyze the clinical outcome of 934 primary nasophartngeal carcinoma treated with conventional external beam radiotherapy alone, Methods 34 patients were treated from Jan. 1 , 1999 to Dec. 31,1999. The radiation fields were delineated according to the CT/MRI imaging findings on disease extent. Two lateral opposing isocentric portals with eustomized blockings were used for the nasopharynx and upper neck. The dose delivered to tumor in the nasopharynx was 68-70 Gy/2 Gy fraetion/7 weeks. The doses delivered to the neck was 60-70 Gv/6-7weeks for patients with positive lymph nodes and 50 Gv/ 5weeks for the patients with negative lymph node. Results The 1-, 2-, 3- and 4-year overall survival rate （OS） was 89.5% ,81.9% ,78. 1% and 75.7% , and metastasis-free survival rate （MFS） was 84.0% , 77.2% ,74.4% and 72.0% , respectively. The 1-, 2-, 3- and 4-year disease-free survival rate （DFS） was 80.8%,73.1%,68.5% and 65. 1%, and the relapse-free survival rate （RFS） was 95. 5%,92.7%, 90.3% and 87. 3% , respectively, The overall failure rate was 30.9% （289/934）. At the end of the radiotherapeutic course, the percentage of residual disease was 14.6%. The 4-year loco-regional recurrence and distant metastasis rates after radiotherapy were 7.2% and 9.2%with a median time of 19.3 months and 12.8 months. Conclusion It may be helpful to improve radiotherapy curative effect when the target is individually designed through improving irradiation technique according to CT/MRI findings and by shortening the overall course time, enhancing irradiation dose and strictly implementing QA/QC measures.

关 键 词：鼻咽肿瘤/放射疗法 常规外照射放疗 

分 类 号：R739.63[医药卫生—肿瘤]