常规外照射前后三维适形放射治疗419例鼻咽癌的对照研究  

Randomized control analysis between three-dimensional conformal radiotherapy pre- and post-conventional radiotherapy for 419 primary nasopharyngeal carcinoma patients

作　　者：袁峰[1] 林志仁[1] 陈苏玮[1] 

机构地区：[1]中南大学湘雅医学院附属海口医院暨海口市人民医院放疗科,海南海口570208

出　　处：《中华肿瘤防治杂志》2009年第15期1169-1172,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:比较常规外照射前后三维适形放射治疗初治鼻咽癌对预后和生存质量的影响。方法:419例初治鼻咽癌随机分组对照研究,按92福州分期标准,Ⅰ、Ⅱ、Ⅲ和ⅣA期分别为23、166、141和89例,其中209例常规外照射50Gy后三维适形放射治疗(2D+3D组),210例三维适形放射治疗后常规外照射(3D+2D组),两组治疗剂量、分割方式和总周期基本相同。结果:2D+3D和3D+2D组2～5年局部控制率分别为94.3%、87.1%、83.5%、80.8%和93.7%、89.1%、86.7%、85.5%,χ2值分别为0.056、0.203、0.34和0.419,P值分别为0.833、0.677、0.579和0.522;1、3、5年总生存率分别为96.0%、76.9%、71.2%和95.7%、80.7%、76.4%,χ2值分别为0.06、0.497和0.376,P值分别为0.831、0.487和0.553;两组局部控制率和总生存率随着时间延长差距有加大趋势,2D+3D组下降速度相对较快,3D+2D组在3年后相对平缓。两组口干、张口困难发生率和程度差异无统计学意义,χ2值分别为0.0294、0.0452,P值分别为0.882、0.853。结论:二维治疗前实施三维治疗在不显著增加毒副反应的前提下,有提高局部控制率和总生存率的趋势,继续随访有望得到更乐观的结果。OBJECTIVE： To analyze the treatment results of primary nasopharyngeal carcinoma （NPC） treated by three-dimensional conformal radiotherapy （3D-CRT） pre- and post conventional radiotherapy （CR）. METHODS： A total of 419 primary NPC were treated by 3D-CRT pre- and post conventional radiotherapy, respectively. The stage distribution（by Fuzhou staging system, 1992） was 23,166,141 and 89 patients in stage Ⅰ,Ⅱ,Ⅲ and ⅣA. A total of 209 patients were treated by 3D-CRT post-conventional radiotherapy （2D＋3D group） while 210 were treated by 3D-CRT pre-conventional radiotherapy（3D＋ 2D group） with almost the same total dose, fraction and the course of treatment. RESULTS： The 2-5 year local control rates （LCR） of 2D ＋3D group and 3D＋2D group were 94.3%, 87.1%, 83.5%0, 80.8% and 93.7%, 89.1%, 86.7%, 85.5%, respectively. X^2 were 0.056, 0.203, 0.34, 0.419, and P were0.833, 0.677, 0.579, 0.522. The 1- 3 ,5-yearoverallsurvival（OS） of 2D＋3D group and 3D＋2D group were 96.0%, 76.9%, 71.2% and 95.7%, 80.7%, 76.4% （X2 were 0.06, 0.497, 0.376, and P were0.831, 0.487, 0.553）respectively. There were no significant differences in LCR and OS between two groups, but the LCR and the OS in 3D＋2D group were slightly higher than those in 2D＋3D group from 3 years after therapy. There were no significant differences in morbidity and severity of xerostomia and trismus between two groups （X^2 were 0. 029 4 and 0. 045 2, P were 0. 882 and 0. 853 ） respectively. CONCLUSIONS： Comparing with 3D-CRT post-conventional radiotherapy, 3D-CRT pre conventional radiotherapy is likely to increase the local control and the overall survival rates but not augment side reactions. Continue follow up visits perhaps gain more optimistic results.

关 键 词：鼻咽肿瘤/放射疗法 三维适形放射治疗 外照射 对照研究 

分 类 号：R739.63[医药卫生—肿瘤]