儿童鼻咽癌远期疗效分析  

An analysis of the long-term results of pediatric nasopharynx cancer

作　　者：陈建武[1] 潘建基[2] 林少俊[2] 杨凌[2] 陈梅[2] 郑崴[2] 陈传本[2] 张春[2] 

机构地区：[1]福建医科大学附属第二医院放疗科,福建泉州362000 [2]福建医科大学教学医院福建省肿瘤医院放疗科,福建福州350014

出　　处：《现代肿瘤医学》2007年第10期1406-1409,共4页Journal of Modern Oncology

摘　　要：目的:回顾性分析儿童鼻咽癌的远期治疗效果并探讨其治疗策略。方法:1986年～2000年本院收治的儿童鼻咽癌35例,单纯放疗18例(RT组),诱导化疗+放疗17例(C+RT组);放疗剂量≤60Gy13例,>60Gy22例。治疗后失败13例,均予以补救性化疗±放疗。结果:儿童鼻咽癌占同期治疗的所有鼻咽癌患者的0.4%,病理以低分化鳞癌为主,占94.1%,入院时III+IV期占88.6%,全组5年总生存率(overallsur-vival,OS)为57.1%。C+RT组与RT组相比,5年无远处转移生存率(progression free survival,PFS)明显增高,(94.1%vs44.4%,P=0.003),从而提高OS(76.5%vs38.9%,P=0.04)。肿瘤剂量>60Gy的5年局部无复发率(locally relapse-free survival,LFRS)及OS均优于≤60Gy的患者,LFRS分别为72.7%vs30.8%,P=0.02,OS分别为90.9%vs53.8%,P=0.004。治疗后失败率37.1%,再治疗后平均继续生存32个月。严重远期并发症的发生率14.3%,均发生于>60Gy的患者,而且80%见于C+RT组。结论:儿童鼻咽癌预后较好,尽管入院时多数已属晚期。诱导化疗可以减低远处转移率,从而提高总生存率。肿瘤剂量以>60Gy为宜,为避免严重并发症的发生,剂量不宜过高,建议60Gy～65Gy。治疗失败患者经积极补救治疗仍可望获得较好的疗效。Objective：Retrospectively analyze the long-term results of pediatric nasopharynx cancer.The strategies of treatment are also to be discussed.Methods：Thirty five cases with pediatric nasopharynx cancer treated in our hospital from 1986 to 2000 were observed,18 patients received radiotherapy alone（group RT）,18 chemotherapy plus radiotherapy（group C＋RT）,13 cases were treated with radiation doses ≤60 Gy while 22 received 〉60 Gy.All the 13 relapses were treated by salvage chemotherapy,added or not by a palliative radiotherapy.Results：The patients of pediatric nasopharynx cancer（NPC） counted for 0.4% of all the patients of NPC treated at the same period in our hospital.The most frequent（91.4%） pathological type was high-grade squamous carcinoma.88.6% was in stages III＋IV when admission.The 5-year overall survival（OS） for all patients was 57.1%.The 5-year progression free survival（PFS） of group C＋RT and group RT were 94.1% and 44.4%,respectively,P=0.003,thus improving the 5-year OS,which were 76.5% and 38.9%,respectively,P=0.04.The 5-year locally relapse-free survival（LFRS） of those treated with radiation doses 〉60 Gy and ≤60 Gy was 72.7% vs 30.8%,P=0.02,and OS 90.9% vs 53.8%,P=0.004.The overall relapse rate was 37.1%,and mean survival of 32 months was obtained after re-treated.The rate of serious side effects was 14.3%,all occurred in patients treating dose 〉60 Gy,and 80% was found in group C＋RT.Conclusion：Pediatric nasopharynx cancer has a good prognosis,although most of the patients have been in advanced stage when admission.Induction chemotherapy could decrease the rate of distant metastases and increase survival.It is reasonable to select treaiting dose 〉60 Gy to ensure a good local control.In order to avoid the serious adverse events,the dose should not be too high and a dose of 60Gy^65 Gy is proposed.In case of relapse,a good result could be achieved by salvage treatment.

关 键 词：鼻咽肿瘤 儿童 放射治疗 化疗 

分 类 号：R739.650.5[医药卫生—肿瘤]