头颈部肿瘤调强放疗联合手术和化疗的回顾性分析  

A retrospective study of intensity modulated radiation therapy combined with surgery and chemotherapy in the treatment of head and neck cancer

作　　者：杨华[1] 石梅[1] 王建华[1] 肖锋[1] 罗山泉[1] 谭丽娜[1] 龙晓丽[1] 刘晓莉[1] 许林[1] 

机构地区：[1]第四军医大学西京医院放疗科,西安710032

出　　处：《实用口腔医学杂志》2012年第2期214-218,共5页Journal of Practical Stomatology

基　　金：国家自然科学基金资助(编号:30870744)

摘　　要：目的:回顾性分析头颈部肿瘤调强放疗(IMRT)的长期随访结果和影响预后的因素。方法:136例初治头颈部肿瘤接受全程IMRT,48例(35.3%)联合化疗。手术联合放疗平均剂量62.14 Gy(50～73 Gy),根治性放疗平均剂量68.99 Gy(56.4～77 Gy)。结果:中位随访时间19个月,3年局控率、区域控制率、无远处转移生存率、无瘤生存率和总生存率分别为83.2%、93.2%、75.8%、66.4%、67.6%。多因素分析显示临床分期、治疗模式、放疗前有无贫血是影响患者生存率的独立预后因素。急性0、1、2、3级皮肤反应发生率分别为3.7%,71.3%,24.3%,0.7%;0、1、2、3、4级黏膜反应发生率分别为4.4%,22.8%,57.4%,14.7%,0.7%。治疗结束1年后1、2、3度口干发生率分别为21.3%、16.2%、0.7%。结论:IMRT联合手术和化疗治疗头颈部肿瘤可取得较好疗效,不良反应可以耐受。临床分期、治疗模式、放疗前有无贫血是影响生存的主要因素。Objective： To investigate the long-term outcome and prognostic factors in patients with head and neck cancer treated by intensity modulated radiation therapy（IMRT）.Methods： 136 patients with head and neck cancer were treated by IMRT（n=88） or IMRT combined with concurrent chemotherapy（n=48）.Results： After a median follow-up of 19 months,the 3-year local control rate,regional control rate,distant metastasis-free rate,disease free survival and overall survival rate（OS） were 83.2%,93.2%,75.8%,66.4% and 67.6% respectively.Multivariate analyses revealed that Clinical stage,treatment model,anemia before radiotherapy were independent predictors for OS.The incidence rate of grade 0,1,2 and 3 acute skin reaction was 3.7%,71.3%,24.3% and 0.7%;the incidence rate of grade 0,1,2,3 and 4 mucosa damage was 4.4%,22.8%,57.4%,14.7% and 0.7% respectively.Conclusion： IMRT combined with chemotherapy and surgery can improve the local-region control and overall survival of the patients with primary head and neck cancer.clinical stage,treatment model,anemia before radiotherapy are the main factors for prognosis.Acute and late toxicities are acceptable.

关 键 词：头颈部肿瘤 调强放疗 手术 化疗 回顾性研究 预后分析 

分 类 号：R739.91[医药卫生—肿瘤]