90例初治鼻咽癌调强适形放疗临床疗效研究  

Intensity modulated radiation therapy for 90 untreated nasopharyngeal carcinoma

作　　者：魏瑞[1] 蒋文娟[1] 苏霁清[1] 贺礼理[2] 杨振[1] 姜武忠[1] 

机构地区：[1]中南大学湘雅医院肿瘤科,长沙410008 [2]湖南省肿瘤医院放疗科,长沙410013

出　　处：《中南大学学报（医学版）》2012年第2期173-178,共6页Journal of Central South University ：Medical Science

基　　金：湖南省教育厅重点学科科研项目(湘财教指[2009]72号);湖南省科技厅科技计划项目(2010FJ3039)~~

摘　　要：目的：观察调强适形放射治疗（intensity modulated radiation therapy,IMRT）在初治鼻咽癌放疗中的临床疗效及不良反应。方法：按1992年福州临床分期标准,I期3例（3.3%）,Ⅱ期29例（32.2%）,Ⅲ期26例（28.9%）,Ⅳa期32例（35.6%）。调强放疗设鼻咽大体肿瘤计划靶区为PGTVnx、颈部阳性淋巴结GTVnd、高危计划靶区PTV1和低危计划靶区PTV2。处方剂量分别为PGTVnx 71.94~77.88 Gy/33次、GTVnd 69.96 Gy/33次、PTV1 60~66 Gy/33次、PTV2 50.4~56 Gy/28次,化疗方案包括同期与辅助化疗。生存率用Kaplan-Meier法计算。多因素分析用Cox比例风险模型。采用放射治疗肿瘤协作组（Radiation Therapy Oncology Group,RTOG）标准评价急性反应和晚期损伤。结果：随访12~56（中位时间33）个月,全组l,2,3,4年总生存率分别为97.8%,90.6%,86.0%,80.0%;1,2,3,4年局部/区域控制生存率分别为98.8%,97.5%,92.1%,77.4%;1,2,3,4年无远处转移生存率分别为95.3%,90.7%,88.4%,85.8%。多因素分析表明临床分期是影响鼻咽癌生存率的独立预后因素。最严重的急性不良反应是放射性黏膜炎,1~4级分别为16.7%,60%,23.3%,0。晚期不良反应主要表现为腮腺损伤,1年后腮腺反应按1~4级分别为18.1%,9.6%,0,0。结论：IMRT联合化疗可提高鼻咽癌患者生存率,晚期不良反应率低,局部复发和远处转移是影响患者生存率的主要原因。Objective： To observe the clinical results and the toxicities of normal tissues in untreated nasopharyngeal carcinoma （NPC） treated with intensity modulated radiation therapy （IMRT）. Methods： A total of 90 patients with untreated NPC received IMRT. According to the 1992 Fuzhou staging system, 3 patients were in stage Ⅰ, 29 in stage Ⅱ, 26 in stage Ⅲ, and 32 in stage IVa. For IMRT,the prescription dose was 71.94-77.88 Gy/33f for the planning target volume of the gross tumor volume in the nasopharynx （PGTVnx）; 69.96 Gy/33f for the positive neck lymph nodes （GTVnd）; 60-66 Gy/33f for the planning target volume of the high risk regions （PTV1）; and 50.4-56 Gy/28f for the planning target volume of the low risk regions （PTV2）. Chemotherapyincluded concurrent and adjuvant protocols. The overall survival rate, local control rate, and distant metastasis-free survival rate were estimated by Kaplan-Meier method. Cox regression was used for multivariate analysis. Acute and 1ate toxicities were graded according to RTOG radiation morbidity scoring criteria. Results： The median follow-up time was 33 months （12-56 months）. The 1-, 2-, 3- and 4-year survival rate was 97.8%, 90.6%, 86% and 80%; the local control tate was 98.8%, 97.5%, 92.1% and 77.4%; and the distant metastasis-free survival rate was 95.3%, 90.7%, 88.4% and 85.8%, respectively. The most serious acute toxicity was irradiated inflammation of mocosa with Grade 1 to 4 of 16.7%, 60%, 23.3% and 0, respectively. In the multivariate analysis, clinical stages were the prognostic factors for the survival rate. The most serious toxicity was salivary gland. The rate of grade xerostomia 1-year after the radiotherapy with Grade 1 to 4 was 18.1%, 9.6%, 0 and 0, respectively. Conclusion： IMRT combined chemotherapy can improve the survival rate, and late adverse reaction is obviously decreased. Local recurrence and distant metastasis are the main reasons for low survival rate.

关 键 词：鼻咽癌 调强适形放射治疗 预后 

分 类 号：R739.63[医药卫生—肿瘤]