剂量递增三维适形放射治疗鼻咽癌局部复发临床研究  

Dose Escalation of Three-dimensional Conformal Radiotherapy for Locally Recurrent Nasopharyngeal Carcinoma： Clinic I staging Prospective Randomized Study

作　　者：卢渊全[1] 

机构地区：[1]河南省商丘市第一人民医院,467100

出　　处：《中国临床实用医学》2009年第4期9-11,共3页China Clinical Practical Medicine

摘　　要：目的 前瞻性研究三维适形放射治疗（Three—dimensional Conformal Radiotherapy 3D-CRT）推量技术对鼻咽癌局部复发的放射治疗剂量递增的可行性和疗效。方法随机选取2004年8月至2007年8月本院36例鼻咽癌局部复发的患者。治疗方法：先用6MVX线常规放疗50Gy／25次／5周，再用3D—CRT推量。随机分为三组，Ⅰ组16Gy（4Gy／次×4）：Ⅱ组20Gy（4Gy／次×5）：Ⅲ组24Gy（4Gy／次×6）。每组各12例。所有推量放疗均为每周3次。中位随访时间27月（14～44）个月。结果患者无Ⅵ级严重的毒性反应发生。放疗急性和晚期并发症各组间无统计学意义。3年总生存率65％、总局部无进展生存率45％和总远处转移率10％。高剂量第三组（74Gy）的局部无进展生存率（72％）显著高于第一组和第二组。三组间3年总远处转移率相似。三组间3年总生存率也无明显差别。单因素分析表明颅底受累和组织学特征为有意义的预后因子。结论3D-CRT高剂量的推量放疗对鼻咽癌局部复发可提高其局部控制率，毒性反应是可耐受的。推量至74Gy比较低剂量的方案产生更好的无局部复发生存率。Objective To investigate the feasibility and efficacy of dose escalation using three-dimensional eonformal radiotherapy （3 D-CRT）boost technique for locally recurrent nasopharyngeal carcinoma （NPC）in a randomized study. Methods Thirty-six patients with locally recurrent NPC were treated between August 2004 and August 2007 at our institution. Patients were treated with external-beam radiotherapy using small shaped fields to 50 Gy/25 fractions/5 weeks,followed by a 3D-CRT boost to the gross tumor region. Patients were randomized to three boost dose levels： 16 Gy （4 Gy × 4 fractions）for Group Ⅰ ：20;Gy （4 GyX5 fractions）for Group Ⅱ;and 24 Gy （4 Gy×6 fractions）for Group Ⅲ. All boost doses were delivered as 3 fractions per week. Twelve patients were enrolled in each group. Median follow-up was 27 months（ range 14 -44 months）. Results There was no significant difference among the three groups in acute and late toxicity. Overall 3-year survival rate was 65 %, 3-year local recurrence-free survival rate was 45 % , and 3-year distant metastasis rate was 10%. The local recurrence free survival was significantly higher（ 72% ）for the high-dose GroupⅢ than that for Groups Ⅰ and Ⅱ. The 3-year distant metastases rates were no significant difference in Group Ⅰ , Ⅱ , Ⅲ respectively. There was no significant difference in the 3-year overall survival rate among the three groups. Univariate analysis revealed that skull base invasion and pathology were significant prognostic factors foroverall survival rate. Conclusion Re-irradiation with high-dose 3D-CRT boost results in high local control rate and acceptable toxicity in with recurrent NPC. Dose escalation to the boost volume to 74 Gy（ 54 Gy ＋ 24 Gy boost）results in improved recurrence-free survival to lower doses.

关 键 词：3D-CRT 再放疗 复发 鼻咽癌 剂量递增 

分 类 号：R730[医药卫生—肿瘤] R73[医药卫生—临床医学]