连续常规分割放射治疗鼻咽癌的疗效分析  

An analysis of continuous conventional fractionated radiotherapy(CCFRT) for nasopharyngeal carcinoma

作　　者：王一鸣[1] 符强[1] 林少民[1] 孔飞[1] 陈显钊[1] 唐启信[1] 

机构地区：[1]海南省人民医院放射治疗科,海南海口570311

出　　处：《中国癌症杂志》2006年第7期568-571,共4页China Oncology

摘　　要：背景与目的：鼻咽癌是常见的头颈部恶性肿瘤，放射治疗是主要的治疗手段，也是主要的根治方法，根据现代放射生物学的研究结果，克隆源性肿瘤细胞在治疗过程中的加速增殖是治疗失败的主要原因，因此，在放射治疗中时间因素越来越受到重视。本研究探讨连续常规分割放射治疗鼻咽癌的价值。方法：116例首程鼻咽癌患者前瞻性随机分组，连续常规分割放射治疗（CCFRT）组56例，常规分割放射治疗（CFRT）组60例。采用6MVX直线加速器外照射。研究组（CCF）：T2-3 DT58—62Gy／29～31d，T4 DT64～66Gy／32～33d，No DT46—50Gy／23～25d，N1-3 DT56—60Gy／28—30d，都是每天一次2．0Gy，每周七天。对照组（CF）：L2-3 DT 66～70Gy／45～47d，T4 DT72～74Gy／50～51d，No DT54—56Gy／37—38d，N1-3 DT64～68Gy／44～46d，每天一次2．0Gy，每周五天。N3期患者均配合化疗。结果：治疗结束时鼻咽病灶临床全消率在CCF组为82．1％，3、6个月时各为91．1％和100％，CF组分别为73．3％、85％和95％，颈淋巴结全消率CCF组为64．3％，3、6个月时各为94．6％和100％，CF组分别是为65％、91．7％和93．3％。3、6个月CT／MRI所示肿瘤全消率CCF与CF各为90．7％（39／43）、96。2（51／53）和83．3％（30／36）、90．2％（46／51）。1、3、5年局控率和生存率CCF与CF比较各为100％、94．6％和85．7％比100％、91．7％和81．7％；98．2％、91．1％和67．9％比98．3％、88．3％和53．3％（以上均P〉0．05）。两组早期反应接近，后期损伤（张口困难、口干、听力下降及颈组织纤维化）CCF较CF明显减轻（P〈0．05）。结论：CCFRT方案能够缩短全疗程时间，提高局控率和生存率，降低晚期并发症，提高生存质量，是一种可行的治疗方法，本研究尚有待大样本前瞻性随机临床研究和长期观察。Background and purpose： Nasopharyngeal carcinoma （NPC） is one of the most common malignant tumors in head and neck region. Radiotherapy is an important radical treatment for NPC. According to the recent research results of radiobiology, during radiotherapy the accelerated repopulation of tumor clonogenic cells accounted for the main reason of treatment failure. The treatment time has been considered as an increasing important factor in radiotherapy. The aim of this paper is to evaluate the treatment effectiveness of continuous conventional fractionated radiotherapy （CCFRT） for NPC. Methods： One hundred and sixteen patients initially diagnosed as NPC were enrolled in this prospective and randomized clinical trial, 56 cases were in the CCFRT trial group, and 60 in the conventional fractionated radiotherapy （CFRT） control group. All patients were irradiated by external beam RT alone with 6MV X-ray. For CCFRT group, patients with T2-3 were given 58 - 62Gy/29 - 31 d, T4 64 - 66 Gy//32 - 33d; NO 46 - 50Gy/23 - 25d and N1-3 56 - 60Gy/28 - 30d with 2Gy per day, 7 days a week. For CFRT group, patients with T2-3 were given T2-3 66 -70Gy/45 -47d, T4 72 -74Gy/50 - 51d, No 54- 56Gy/37 -38d, and N 1-3 64 -68Gy/44 -46d. 2Gy per day and 5 days a week. All N3 patients were given supplementary chemotherapy. Results： Complete response （CR） rates of primary cancer for CCFRT group were 82. 1% at the time of RT completion, 91.1% and 100% at 3 and 6 months after the completion of RT; and for CFRT group were 73.3%, 85% and 95%, respectively. CR rates in neck nodes for CCFRT group were 64.3%, 94.6% and 100% ; and for CFRT group were 65%, 91.7% and 93.3%, respectively. CR rates for CCFRT and CFRT evaluated by CT and/or MRI at 3 and 6 months after RT were 90.7% vs. 83.3%, and 96.2% vs. 90.2%. Local control and survival rates at 1, 3 and 5 years were 100%, 94.6% and 85.7% for CCFRT vs. 100%, 91.7% and 81.7% for CFRT, and 98.2%, 91.1% and 67.9% for CCFRT vs. 98.3%, 88.3% and 53.3% CFRT, respectively （P 〉0.05）. Acu

关 键 词：鼻咽癌 放射治疗 疗效 

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