鼻咽癌小靶区调强放疗及化疗的远期疗效分析  

Long-term outcome of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiotherapy and chemotherapy

作　　者：林少俊[1] 潘建基[1] 韩露[1] 陈传本[1] 张瑜[1] 郭巧娟[1] 宗井凤[1] 林锦[1] 张秀春[1] 

机构地区：[1]福建省肿瘤转化医学重点实验室福建医科大学教学医院福建省肿瘤医院放疗科,福州350014

出　　处：《中华放射肿瘤学杂志》2013年第5期378-382,共5页Chinese Journal of Radiation Oncology

基　　金：福建省自然科学基会（C0310034）;福建省卫生厅临床重点专科建设项目（2012）

摘　　要：目的分析鼻咽癌（NPC）缩小临床靶区调强放疗（IMRT）的长期疗效，为小靶区IMRT技术在NPC中应用提供依据。方法2003--2007年接受IMRT的鼻咽癌患者413例，中位年龄45岁，男311例、女102例。按第6版AJCC分期标准I期3例、Ⅱ期66例、Ⅲ期235例、M期78例、IVb期31例。336例患者接受了以铂类为基础的化疗。结果随访率100％，5年总生存率、局部控制率、无区域复发生存率、无远处转移生存率和无瘤生存率分别为80％、93％、96％、81％和75％。多因素分析提示T分期、N分期、年龄是影响总生存的预后因素（P=0．001、0．001、0．002），T分期、N分期是无远处转移生存的预后因素（P=0．000、0．001）。进展期鼻咽癌患者中诱导化疗组5年总生存有高于无诱导化疗组趋势（78％：68％，P=0．053），辅助化疗者5年无远处转移生存率低于无辅助化疗者（65％：83％，P=0．003）。结论鼻咽癌小靶区IMRT技术安全可靠，远期疗效理想。Objective To analyze the long-term outcome of nasopharyngeal carcinoma （NPC） patients treated with intensity-modulated radiotherapy （IMRT） with reduced clinical target volume （CTV） and to provide a basis for the application of reduced - volume IMRT in the treatment of NPC . Methods Between November 2003 and April 2007, 413 patients with NPC were treated with IMRT according our institutional protocol. The median age was 45 years;the patients included 311 males and 102 females. Of all patients, 3（0. 7% ） had stage I NPC, 66（ 16% ） had stage II NPC, 235（56. 9% ） had stage III NPC, 78 （ 18.9% ） had stage [Va NPC, and 31 （7.5%） had stage IVb NPC, according to the 6th edition of AJCC staging system. IMRT was delivered as follows ： GTV 66. 00 -69. 75 Gy/30-33 f; CTV-1 60.00 -66. 65 Gy/30-33 f; CTV-2/CTV-N 54. 0 -55.8 Gy/30-33 f. A total of 336 patients received cisplatin-based chemotherapy in addition to IMRT. Results The follow-up rate was 100%. With a median follow-up of 72 months, the 5-year overall survival （OS）, local control, loco-regional recurrence-free survival, distant metastasis-free survival （DMFS）, and disease-free survival rates were 80%, 93%, 96%, 81%, and 75% , respectively. The multivariate analysis revealed that T stage, N stage, and age were independent prognostic factors for OS （ P = 0. 001,0. 001,0. 002 ） ; T stage and N stage were independent prognostic factors for DMFS （P =0. 000,0. 001）. Among patients with stage m and IV NPC, the 5-year OS rate was nonsignifieantly higher in those treated with induction chemotherapy than in those not treated with induction chemotherapy （78% vs. 68%, P= 0. 053）, but the 5-year DMFS rate was significantly lower in those treated with adjuvant chemotherapy than in those not treated with adjuvant chemotherapy （65% vs. 83% , P = 0. 003 ）. Conclusions IMRT with reduced CTV is safe and reliable and can lead to a good long-term outcome in patients with NPC.

关 键 词：鼻咽肿瘤 调强放射疗法 鼻咽肿瘤 化学疗法 预后 

分 类 号：R739.63[医药卫生—肿瘤]