全靶区同期整合补量调强放疗治疗鼻咽癌  

Clinical results of whole-field simultaneous integrated-boost intensity-modulated radiotherapy for untreated nasopharyngeal carcinoma

作　　者：高军茂[1] 郑明民[1] 许卫东[1] 姚波[1] 蒋华勇[1] 王平[1] 张富利[1] 赵一虹[1] 何合良[1] 

机构地区：[1]北京军区总医院放疗科,北京100700

出　　处：《中国耳鼻咽喉头颈外科》2011年第8期414-418,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的回顾性分析全部靶区、全程同期整合补量调强放疗(whole-field simultaneous integrated-boost intensity-modulated radiotherapy,WF-SIB IMRT)鼻咽癌的效果。方法 2005年10月至2009年11月经病理证实的42例鼻咽癌患者接受调强放疗(intensity-modulated radiotherapy,IMRT),I～IIb期13例,III～IVb期29例。处方:(gross target volumes,GTV)2.1～2.3 Gy/次,(clinical target volumes 1,CTV1)1.9～2.0 Gy/次、(clinical target volumes 2,CTV2)1.8 Gy/次,放射总剂量分别为70～80.5、62.7～70.0、50.4 Gy。12例患者治疗后有病灶残存,局部立体定向照射5～18.9 Gy。RTOG评分标准记录照射反应,Kaplan-Meier法计算生存率。结果中位随访时间32个月(12～63个月),4年局部控制率、区域控制率、无转移生存率和总生存率分别为93.0%、97.4%、74.0%和86.2%;急性反应主要为1～2级黏膜和唾液腺反应,分别为90.5%和85.7%;晚期为1级口干(47.6%)。结论 IMRT鼻咽癌靶区达到了较理想的剂量分布,并降低了周围危及器官剂量。局部、区域控制率高,降低了3～4级急、慢性反应,失败的主要原因是远处转移。OBJECTIVE To retrospectively review the outcomes of nasopharyngeal carcinomas treated with intensity-modulated radiotherapy（IMRT）using a whole-field simultaneous integrated-boost technique（WF-SIB）.METHODS Between Oct.2005 and Nov.2009,42 pathologically proved,non-metastasis patients treated with IMRT were eligible in this study.The distribution of disease was Stage I to IIB in 13 cases,Stage III to IVb in 29 cases.We prescribed 70-80.5 Gy and 62.7-70.0 Gy delivered in 33-35 fractions at the gross target volumes（GTV）and clinical target volumes 1（CTV1）respectively,and 50.4Gy delivered in 28 fractions at the clinical target volumes 2（CTV2）.Twelve patients who suspected residual disease at the end of IMRT received a fractionated stereotactic boost,5-18.9 Gy.Normal tissue effects were graded according to the Radiation Therapy Oncology Group（RTOG）radiation morbidity scoring criteria.Local control rate（LC）,regional control rate（RC）,distant metastasis free survival（DMFS）and overall survival rate（OS）were estimated by Kaplan-Meier method.RESULTS The median follow-up period was 32 months（range 12-63 months）.The 4-year estimates of LC,RC,DMFS and OS rate were 93.0%,97.4%,74.0%,and 82.2%,respectively.Acute toxicity was mostly grade 1 to grade 2 of mucositis and salivary gland reaction（90.5% and 85.7% respectively）.Late toxicity was mainly grade 1 of xerostomia（47.6%）.CONCLUSION WF-SIB intensity-modulated radiotherapy for untreated nasopharyngeal carcinomas not only improve the targets volume coverage,but also significantly spare of the salivary gland and nearby normal structures.IMRT results in good local-regional control rate and lower grade 3 to 4 side effects.The patterns of failure are mainly distant metastasis.

关 键 词：鼻咽肿瘤 放射疗法 调强适形 预后 

分 类 号：R739.63[医药卫生—肿瘤]