中国西北地区133例鼻咽癌调强放疗的预后分析  

Prognosis analyses of 133 nasopharyneal carcinoma from northwest China treated by intensitymodulated radiotherapy

作　　者：周彬[1] 石梅[1] 王建华[1] 罗山泉[1] 许曼[1] 赵丽娜[1] 李剑平[1] 肖锋[1] 刘晓莉[1] 谭丽娜[1] 龙晓丽[1] 

机构地区：[1]第四军医大学西京医院放疗科,西安710032

出　　处：《中华放射肿瘤学杂志》2011年第5期374-378,共5页Chinese Journal of Radiation Oncology

摘　　要：目的分析中国西北地区初治鼻咽癌调强放疗（IMRT）疗效、不良反应和影响预后因素。方法2006--2009年在本院接受全程IMRT的133例患者入组分析，其中22例单纯放疗，111例接受以铂类为基础的同期放化疗。鼻咽大体肿瘤体积66．0—76．6Gy分30—33次，颈部阳性淋巴结66．0～72．4Gy分30—33次，高危临床靶体积56．0—63．5Gy分28—33次，低危临床靶体积50．4～53．2Gy分28次。结果随访率为97．7％，随访时间满2、3年者分别为37、44例。1、2、3年总生存率分别为93．8％、88．3％、83．2％；局部控制率分别为99．2％、95．4％、95．4％；区域控制率分别为99．2％、96．8％、96．8％；无远处转移率分别为82．8％、79．8％、79．8％；无瘤生存率分别为84．3％、76．7％、76．7％。多因素分析显示N分期、年龄及放疗前是否贫血是影响总生存率的因素（X^2=5．56、9．10、4．89，P=0．018、0．003、0．027），同时N分期还是影响无瘤生存率的因素（X^2=8．98，P=0．003）。3级急性不良反应率分别为皮肤1．4％、口腔黏膜34．7％、唾液腺20．1％、骨髓抑制1．4％。全组未观察到4级急性和晚期不良反应。结论中国西北地区初治鼻咽癌患者IMRT能获得较好局部、区域淋巴结控制率及总生存率，不良反应可耐受，远处转移仍是治疗失败的最主要模式，N分期、发病年龄、放疗前有无贫血是影响生存的主要因素。Objective To evaluate the long term outcomes, toxicities and prognostic factors of the patients in Northwest China with nasopharyngeal carcinoma （NPC） treated by intensity-modulated radiotherapy （IMRT）. Methods From January 2006 to December 2009, 133 NPC Patients were treated by IMRT in Xijing Hospital, the Fourth Military Medical University. There were 22 treated by radiotherapy alone, 111 treated by platinum-based current chemo-radiothreapy. The prescription dose to the gross tumor volume was 66 - 76. 6 Gy/30 - 33 fractions, positive lymph nodes was 66.0 - 72. 4 Gy/30 - 33 fractions. The higher and lower risk clinical target volume were irradiated with 56. 0 - 63.5 Gy/28 - 33 fractions and 50. 4 -53.2 Gy/28 fractions respectively. Results The follow-up rate was 97.7%. Follow-up time more than 2years,3years were 37cases ,44cases. The 1-,2-and 3-year overall survival （OS） were 93.8% , 88.3% and 83.2% ;local control rate were 99.2% ,95.4% and 95.4% ;regional control rate （RC） were 99. 2% , 96. 8% and 96. 8% ; and distant metastasis-free rate （DMFR） were 82. 8% , 79. 8% and 79. 8% ; the disease-free survival （DFS） were 84. 3% ,76. 7% and 76. 7% , respectively. Multivariate analyses revealed that N stage, age and anemia before radiotherapy were independent predictors for OS （ X2 ---~ 5. 56,9. 10, 4. 89,P = 0. 018,0. 003,0. 027 ）, and N stage was also independent predictors for DFS （X2 = 8.98, P = 0.003）. The grade 3 acute toxicities were mucositis （34.7%）, xerostomia （20.1%）, skin reaction （ 1.4 % ） and leucocytopenia （ 1.4 % ）. No grade4 acute and late toxicities were detected. Conclusions IMRT with or without chemotherapy achieved good long term survival in nasopharyngeal carcinoma treated by intensity-modulated radiotherapy, especially in LC and RC. Distant metastasis becomes the main treatment failure. N stage, age, and anemia before radiotherapy were the main prognostic factors in nasopharyngeal cancer patients.

关 键 词：鼻咽肿瘤/放射疗法 放射疗法 调强 预后 

分 类 号：R739.63[医药卫生—肿瘤]