3种分割式放疗对鼻咽癌患者远期疗效的比较  

Comparison of long-term results in three types of fraction radiotherapy for nasopharyngeal carcinoma

作　　者：谭永红[1] 杨晓霞[1] 郑成位[1] 雷新[1] 单锦露[1] 王东[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所肿瘤中心,重庆400042

出　　处：《解放军医学杂志》2005年第11期967-969,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的比较常规分割、全程超分割、后程加速超分割3种方法放射治疗鼻咽癌患者的远期疗效及晚反应组织损伤的发生率。方法128例首程放疗的鼻咽癌患者随机分为常规分割治疗(CFR)组、全程超分割治疗(FHR)组、后程加速超分割治疗(LAHR)组。鼻咽部总剂量:CFR组70～72Gy/7～7.5周,每天照射1次,每次2Gy;FHR组80.5～82.8Gy/7～7.5周,每天照射2次,间隔6h以上,每次1.15Gy;LAHR组先常规分割照射38～40Gy/3.5～4周,再加速超分割照射33～36Gy/2～2.5周,每天2次,间隔6h以上,每次1.5Gy。结果1、3、5年的局部控制率CFR组为87.3%、69.8%、58.1%,FHR组为88.0%、80.0%、75.0%,LAHR组为100%、86.0%、83.7%,1、3年局控率3组无显著性差异,但5年局控率LAHR组和FHR组明显高于CFR组(P<0.05)。1、3、5年的总生存率CRF组为95.3%、62.7%、53.5%,FHR组为97.6%、76.2%、61.9%,LAHR组为100%、86.1%、69.8%,无显著性差异。1、3、5年无瘤生存率CFR组为79.1%、41.9%、35.6%,FHR组为85.7%、57.1%、38.1%,LAHR组为95.4%、62.8%、58.1%,有显著性差异(P<0.05)。听力下降发生率CFR组为31.3%,FHR组为25.0%,LAHR组为22.7%;张口困难发生率CFR组为41.9%,FHR组为35.7%,LAHR组为27.9%;放射性脑病发生率CFR组为9.3%,FHR组为7.1%,LAHR组为7.0%;3组的晚反应发生率无显著性差异。结论LAHR和FHR组5年局部控制率和无瘤生存率明显高于CFR组,但3种分割放疗方式对鼻咽癌患者5年总生存率和晚正常组织损伤发生率无明显影响。Objective To compare the long-term clinical results and the incidence of late complication in patients with nasopharyngeal carcinoma receiving either conventional fraction radiotherapy, full-course hyper-fractionated radiotherapy or late-course accelerated hyperfractionated radiotherapy. Methods 128 patients with nasopharyngeal carcinoma were randomized into three groups and treated either with conventional fraction radiation （CFR） （43 cases）, full-course hyper- fractionated radiation （FHR） （40 cases） or late-course accelerated hyper-fractionated radiation （LAHR） （43 cases）. Patients in CFR group received 2Gy/F, 5 Fraction/week with the total dose of 70- 72Gy/7-7. 5 weeks, those in FHR group received 2 Fraction/day with 6-hour interval, 1.15Gy/F with total dose of 80.5-82.8Gy/7- 7.5 weeks, and those in LAHR group received conventional fraction radiotherapy of 38-40Gy/3. 5-4 weeks first, and then received the accelerated hyper-fractionated radiotherapy for 2-2. 5 weeks （1.5Gy/F, 2F/day with 6 hour interval）, with the total dose of 33-36Gy. Results The 1-, 3-, and 5-year local control rate was 87. 3%, 69. 8% and 58. 1% in CFR group, 88. 0%, 80. 0% and 75. 0% in FHR group, and 100%, 86.0% and 83. 7% in LAHR group, respectively. No differences were noted in the 1- and 3-year local control rate among three groups （x^2=3. 038 and 3. 581, P〉0. 05）. However, the 5-year local control rate appeared significantly different in three groups （X^2=7.239, P〈0.05）. The 1 -, 3- and 5-year overall survival rate was 95.3 %, 62. 7 % and 53. 5 % in CFR group, 97.6 %, 76.2% and 61.9% in FHR group, 100%, 86.1% and 69.8% in LAHR group, respectively and no difference was noted （X^2 =3.29, P〈0. 05）. The 1- ,3- ,and 5-year disease-free survival rate among three groups were significantly different in the three groups （79. 1%, 41.9% and 35. 6% for CFR group, 85. 7%, 57.1% and 38. 1% for FHR group, and 95.4%, 62. 8% and 58. 1% for LAHR group） （X^2 =6.60,P〈0.05）. A similar incidence of lat

关 键 词：鼻咽肿瘤 超分割放疗 存活率 晚反应组织损伤 

分 类 号：R739.6[医药卫生—肿瘤]