T_(3～4)N_(0～1)M_0期鼻咽癌常规分割与后程加速超分割放疗的远期分析  

Comparison of long-term results of conventional fractionation radiotherapy and late course accelerated hyperfractionation radiotherapy for nasopharyngeal carcinoma of stage T_(3～4)N_(0～1)M_0

作　　者：高健全[1] 蔡永林[1] 董智荣 高天生 董桂宏 吴惠惠[1] 李赓[1] 

机构地区：[1]梧州市红十字会医院肿瘤科,广西梧州543002

出　　处：《实用肿瘤杂志》2012年第6期626-629,共4页Journal of Practical Oncology

摘　　要：目的通过对比分析常规分割(CF)放疗与后程加速超分割(LCAHF)放疗T3～4N0～1M0期鼻咽癌的远期疗效,以探索更好的鼻咽癌放疗方案。方法回顾性分析符合入组条件的358例T3～4N0～1M0期鼻咽癌患者。其中CF组186例,LCAHF组172例。两组患者均采用面颈联合野或耳前野对穿照射,2 Gy/次,5次/周,放疗至36～40 Gy后改为双耳前野避开脊髓继续放疗,CF组继续用原分割方案放疗至74～78 Gy,LCAHF组改用1.5 Gy/次,2次/日,两次之间相隔6-8小时,总剂量72～78 Gy。两组病例颈部均采用常规分割放疗,预防剂量46～50 Gy,治疗剂量64～70 Gy。结果 3、5、8年鼻咽癌原发灶控制率LCAHF组分别为78.5%、65.3%、53.4%,CF组分别为68.8%、51.7%、41.4%,两组差异有统计学意义(P<0.05);LCAHF组3、5、8年生存率分别为75.0%、56.9%、45.4%,CF组分别为70.4%、53.9%、42.0%,两组差异无统计学意义(P>0.05)。进一步按T分期进行分析显示LCAHF显著提高了T3期患者的鼻咽癌原发灶控制率(P<0.01),而对于T4期患者两组差异则无统计学意义(P>0.05)。两组患者急性不良反应及远期放射后遗症相似(P>0.05)。结论与常规分割放疗比较,后程加速超分割放疗提高了T3～4N0～1M0期鼻咽癌的局部控制率,但长期生存率无差别,患者能耐受LCAHF治疗,不增加远期不良反应。Objective To evaluate and compare the long-term therapeutic effects of conventional fractionation（CF） radiotherapy and late course accelerated hyperfractionation（LCAHF） radiotherapy in treatment for nasopharyngeal carcinoma（NPC） of stage T3～4N0～1M0. Methods Clinical data of 358 patients with NPC at T3～4N0～1M0 stage who underwent radiotherapy were retrospectively analyzed,with 172 in CF group and 186 in LCAHF group.Two large lateral opposing fields were first used to treat nasopharynx and upper neck at a fraction of 2 Gy daily,5 d per week.After 36～40 Gy,two small lateral opposing fields were used to boost the primary tumor with the spinal cord shielded.In CF group,the accumulated total dose of nasopharynx was 74～78 Gy.In LCAHF group,the radiation fraction of primary tumor was 1.5 Gy twice daily,with 6-8 h interval in the late course.The accumulated total dose was 72～78 Gy.Results The 3-,5-and 8-y primary site control rates were 78.5%,65.3% and 53.4% in LCAHF group;and 68.8%,51.7% and 41.4% in CF group（P 0.05）.The 3-,5-and 8-y survival rates were 75.0%,56.9% and 45.4% in LCAHF group,and 70.4%,53.9% and 42.0% in CF group（P 0.05）.Further analysis showed that LCAHF improved the primary site control rate of T 3 NPC（P 0.01）,but not of T 4 NPC.No significant difference in the acute radiation toxicities and sequelae was observed between the two groups（P 0.05）.Conclusion Compared with CF radiotherapy,LCAHF improves local control rate and is also more tolerable;however,the long-term survival is similar between two protocols.

关 键 词：鼻咽肿瘤 放射疗法 存活率 放射剂量分次 放射疗法 方法 肿瘤分期 回顾性研究 

分 类 号：R739.63[医药卫生—肿瘤]