基于调强放疗N0期鼻咽癌颈部预防照射的选择  

Volume of prophylactic irradiation to neck for stage NO nasopharyngeal carcinoma patients treatedwith intensity-modulated radiotherapy

作　　者：曾雷[1] 陈春燕[1] 孙学明[1] 韩非[1] 邓小武[1] 卢泰祥[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心放疗科,广州510060

出　　处：《中华放射肿瘤学杂志》2013年第2期133-137,共5页Chinese Journal of Radiation Oncology

摘　　要：目的探讨慕于调强放疗（IMRT）N0期鼻咽癌患者颈部预防照射的方式。方法回顾分析2003--2008年本中心IMRT的270例N0期（第6版AJCC／UICC分期）初治鼻咽癌患者的临床资料，其中171例接受上半颈预防照射，99例接受全颈预防照射。所有患者均接受鼻咽原发灶、上颈部淋巴引流区（包括双颈Ⅱ、Ⅲ、VA区）6MVX线IMRT，鼻咽原发灶剂量为68Cy分30次，上颈剂量为54Gy分30次，疗程6周。全颈预防照射者下颈部及锁骨上采用颈前半野常规技术，剂量为50Gy分25次。结果中位随访65．1个月，随访率为93％。上颈、全颈预防照射的5年肿瘤相关生存率分别为95．3％、91．9％（X2=0．76，P=0．384），颈部无复发生存率分别为99．4％、99．0％（X2=1．18，P=0．278），无远处转移生存率分别为98．8％、94．9％（X2=2．31，P=0．128）。咽后淋巴结阴、阳性患者5年无远处转移生存率分别为99．4％、93．7％（X2=8．96，P=0．003）。急性不良反应主要为1、2级黏膜炎和咽喉炎，无3＋4级张口困难和口干等晚期不良反应。结论N0期鼻咽癌患者IMRT时行卜半颈预防照射也许是可行的，第7版AJCC／UICC将颈淋巴结阴性而咽后淋巴结阳性鼻咽癌上调为N0是合理的。Objective To investigate the volume of prophylactic irradiation to the neck for stage NO nasopharyngeal carcinoma （NPC） patients treated with intensity-modulated radiotherapy （IMRT）. Methods Retrospective analysis was performed on the clinical records of 270 patients with stage No NPC （based on the 6th version of AJCC/UICC staging system） , who underwent IMRT as the initial treatment in our center from 2003 to 2008. Among all the patients, 171 received prophylactic upper-neck irradiation, and 99 prophylactic whole-neck irradiation. All of them received 6-MV X-ray IMRT to the primary focus of NPC and the lymphatic drainage area in the upper neck （ Levels Ⅱ, Ⅲ, and V A lymph nodes ） at doses of 68 Gy/30 fractions and 54 Gy/30 fractions over 6 weeks. In addition, the patients receiving prophylactic whole-neck irradiation had the lower neck and supraclavicular fossae treated by anterior neck semi-field conventional technique at a dose of 50 Gy/25 fractions. Results The median follow-up was 65. 1 months （ range 4--106 months） , and the follow-up rate was 93%. The patients undergoing prophylactic upper-neck irradiation and prophylactic whole-neck irradiation had 5-year disease specific survival rates of 95.3% and 91.9% （ X2 = 0. 76,P = 0. 384） , relapse-free survival rates of 99. 4% and 99. 0% （ X2 = 1. 18, P ： 0. 278 ）, and distant metastasis-free survival rates of 98.8% and 94. 9% （X2 =2. 31 ,P =0. 128）. The 5-year distant metastasis- free survival rate was significantly higher in patients without retropharyngeal lymph node （RLN） metastasis than in those with RLN metastasis （99. 4% vs. 93.7% , X2 =8.96,P = 0. 003 ）. Grade 1--2 mucositis and pharyngitis were the most common acute adverse reactions in patients. At 24 months after IMRT, no grade 3 or 4 xerostomia and trismus were developed. Conclusions Prophylactic irradiation to the upper neck may be feasible for stage No NPC patients treated with IMRT. It is reasonable in the 7th version of AJCC/UICC staging system that NP

关 键 词：鼻咽肿瘤 放射疗法 放射疗法 调强 颈部预防照射 预后 

分 类 号：R739.63[医药卫生—肿瘤]