180例鼻咽癌调强放疗临床分析  

Clinical observation of 180 nasopharyngeal carcinoma patients for intensity modulated radiotherapy

作　　者：马俊刚[1] 杨镇洲[1] 王阁[1] 王东[1] 余娴[1] 雷新[1] 杨晓霞[1] 刘岩海[1] 胡南[1] 倪蓉晖[1] 王继红[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：《重庆医学》2007年第20期2062-2064,共3页Chongqing medicine

摘　　要：目的探讨鼻咽癌调强放疗（intensity modulated radiation therapy，IMRT）的实施，观察近期疗效，并分析其急慢性不良反应。方法鼻咽癌IMRT初治患者180例，按1992年福州分期标准，Ⅰ期13例，Ⅱ期52例，Ⅲ期86例，Ⅳ期29例；鼻咽和上颈淋巴引流区作IMRT，原发灶GTV照射中位剂量72．6Gy（70．4～83、6Gy），2．2Gy／f，下颈淋巴引流区予颈前切线野照射，50～70Gy／2Gy／f。结果随访中位时间24个月（12～48个月），1、2年总生存率分别为100％、94．4％，1、2年无局部复发率分别为96.4％、93.3％，无区域进展生存率分别为98．3％、97．5％，无远处转移生存率分别为90．1％、82.4％。N分期是影响无远处转移生存率的最重要预后因素（P=0．04）。最严重的急性不良反应是放射性黏膜炎，Ⅰ～Ⅳ级分别为26．6％、43．8％、23．3％、1．1％。晚期不良反应主要表现为口干，Ⅰ级37．2％，Ⅱ级7．3％。结论鼻咽癌IMRT靶区剂量高，周围正常组织受量小，不良反应轻微，是一种治疗鼻咽癌的有效方法。Objective To observe the efficiency of nasopharyngeal carcinoma（NPC） treated with intensity modulated radiation therapy（IMRT）,as well as the acute and late toxicities of normal tissue. Methods From Jan 2003 to Feb 2006,180 patients with NPC underwent IMRT at our hospital. According to the 1992 Fuzhou staging systm, 13 patients were stage Ⅰ ,52 patients were stage Ⅱ ,86 patients were stage Ⅲ ,and 2.9 patents were stage Ⅳ. Nasopharynx lesion and its ascendings cervix lymph nodes were irradiated with IMRT. The median dose was 72.6GY,2.2GY per fraction to the primany lesion with GTV. While,descecendings cervix Lymph node of neck was irradiated with neck tangent yield . The dose was SO to 70GY,2GY per fraction. Results The median follow-up interval was 24 month（12-48months）. The 1-year and 2-years overall survival rate were 100%and 94.4% respectively. The 1-year and 2-years loco-regional recurrence-free survival rate were 96.4 % and 93.3 %. The 1-year and 2-year loco-region- al progress free surrivial were 98.3%and 97. 5%. The 1-year and 2-year disease metastasis-free were 90.1%and 82.4%.Lymph node staging was the most important prognosis factor in affecting disease metastasis-free survial rate（P= 0.04）. The most serious acute toxicity was irradited inflammatin of mocosa with Grade Ⅰ to Ⅳ（ of 26.6%,43.8%,23.3% and 1.1% respectively. The late toxicity was mostly salivary gland with Grade Ⅰ37.2% and Grade Ⅱ7.3%. Conclusion IMRT could improve the target volume dose and decrease the dose of surrounding tissue resulting in higher control rate and lower side effet. IMRT is a safe valid method to treat nasopharyngeal carcinoma.

关 键 词：鼻咽癌 调强放疗 预后 

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