初治鼻咽癌调强放疗与常规放疗的同期对照研究  

Concurrent control study of different radiotherapy for primary nasopharyngeal carcinoma:intensity-modulated radiotherapy versus conventional radiotherapy

作　　者：张瑜[1] 林志安[2] 潘建基[1] 郑茁[1] 杨凌[1] 林少俊[1] 郑飞[1] 

机构地区：[1]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 [2]厦门大学附属中山医院肿瘤放疗科,福建厦门361004

出　　处：《癌症》2009年第11期1143-1148,共6页Chinese Journal of Cancer

基　　金：福建省自然科学基金资助项目(No.C0310034;No.2006J0331)~~

摘　　要：背景与目的:调强适形放疗在鼻咽癌治疗中的应用逐渐增多,取得了较好的局部控制率。本研究探讨与常规放疗比较,调强放疗能否提高鼻咽癌患者的生存率并减少放射性损伤。方法:选择2003年11月至2005年12月在福建省肿瘤医院行调强放疗的初治鼻咽癌患者190例为调强放疗组,并按1∶1配对选择同期行常规放疗的190例初治鼻咽癌患者作为对照组,两组共380例患者。随访两组的生存状况以及急性和慢性放射性损伤发生情况,对两组进行生存分析,并比较两组的疗效及放射性损伤的发生率及严重程度。结果:调强放疗组4年无局部复发生存率和局部区域控制率均高于常规放疗组(89.8%vs.80.7%,P=0.029;90.4%vs.78.3%,P=0.0107);而两组的4年无远处转移生存率、无进展生存率和总生存率差异均无统计学意义(88.6%vs.83.4%,79.4%vs.64.8%,88.9%vs.75.8%,P值均>0.05)。调强放疗患者的急性口干、颈部纤维化、张口困难的严重程度以及放疗后6个月、1、2、3、4年的口干反应均明显轻于常规放疗(P值均﹤0.05);但两组的急性黏膜反应、骨髓抑制和慢性听力损伤、放射性颅神经损伤差异均无统计学意义(P值均>0.05)。结论:调强放疗可提高初治鼻咽癌患者的无局部复发生存率及局部区域控制率,并能减轻患者的部分急慢性放射性损伤,但未能提高总生存率。Background and Objective. Intensity-modulated radiotherapy （IMRT） has recently gained popularity in the treatment of nasopharyngeal carcinoma （NPC） and improved the local-regional control rate. This study was to explore whether IMRT could improved the survival rate while reduce the radiation-related injury for primary NPC patients compared with conventional radiotherapy （CRT）. Methods, From Nov. 2003 to Dec. 2005, 190 patients with NPC treated with IMRT in a single hospital were retrospectively analyzed. Another 190 patients treated with conventional radiotherapy at the same period were matched by prognostic factors respectively. The survival status and treatment-induced adverse effects were investigated. Treatment results, the occurrence and severity of adverse effects of two groups were compared. Results, In the treatment of NPC,IMRT was superior to CRT in term of 4-year local regional control rate, relapse-free survival rate without reducing the overall survival rate. But there were no significant differences in the 4-year progress-free survival rate and distant metastasis-free survival rate between the two groups. Significant reductions of the occurrence rates and severity of acute skin reaction, neck fibrosis, trismus and xerostomia were noted in IMRT arm. But there were no differences in mucositis, hematological toxicity, hearing loss and radiation induced cranial neuropathy between IMRT arm and CRT arm. Conclusions： IMRT could improve the local regional control rate and relapse-free survival rate while reduce some radiation-related complications in patients with NPC. But the improvement of overall survival rate did not reach significant level.

关 键 词：鼻咽肿瘤/放射疗法 调强放射治疗 预后 放射损伤 

分 类 号：R739.63[医药卫生—肿瘤]