儿童及青少年鼻咽癌的放射治疗及临床效果分析  

Clinical analysis of radiotherapy in children and adolescents with nasopharyngeal carcinoma

作　　者：张朦[1] 俞志英[1] 周菊英[1] 冯飞[1] 

机构地区：[1]苏州大学附属第一医学放疗科,江苏苏州215006

出　　处：《实用医院临床杂志》2014年第5期172-175,共4页Practical Journal of Clinical Medicine

摘　　要：目的：探讨儿童及青少年鼻咽癌的临床特点、治疗、预后及并发症。方法回顾性分析53例儿童及青少年（≤20岁）鼻咽癌患者的临床资料。结果首发症状以颈部肿块和鼻部症状（血涕、鼻塞）最多见，分别占60.4％和20.7％，多数被误诊为颈部淋巴结炎、淋巴结结核、鼻炎、中耳炎。53例均为首次放射治疗，其中有7例因鼻咽部和颈部复发及3例颈部复发者行第二次放射治疗，照射剂量鼻咽部57～69 gy，颈部60～75 gy，常规分割外照射。22例配合化疗（ PBF或PFA方案3～5周期）。放疗后鼻咽部和颈部均有复发7例，单纯颈部复发3例。5年生存率73.6％（39/53）， II期5年生存率88.2％（15/17），III期及IV期66.7％（24/36）。远地转移11例（占20.8％），其中肺转移3例、全身多处骨转移6例、肝转移2例（均存活不满5年）。放射治疗后遗症主要为龋齿18.0％、颈部软组织纤维化18.0％、记忆力下降13.6％、听力下降9.0％、生长发育迟缓9.0％、张口困难4.5％、语音不清4.5％等。结论儿童及青少年鼻咽癌患者具有发病率低、病期偏晚、预后较好的特点。放射治疗效果较好，早期放射反应出现的比例高、时间早。治疗失败出现远处转移后，继续予以相应的治疗，仍可取的较好的疗效。Objective To investigate the clinical characteristics , treatment , prognosis and complications of nasopharyngeal carcinoma in children and adolescents .Methods Clinical data of 53 children and adolescents （≤20 years） with nasopharyngeal car-cinoma were retrospectively analyzed .Results The most common first symptoms were neck mass and nasal symptoms （ blood tears and nasal congestion ） that accounted for 60.4%and 20.7%, respectively .The majority of patients were misdiagnosed as cervical lymphad-enitis, lymph node tuberculosis, rhinitis or otitis media.All the patients had the first radiotherapy .There were 7 cases of the nasophar-ynx and neck recurrence and 3 cases of recurrence undergoing a second neck radiotherapy .The radiation doses were nasopharynx 57 ~69 gy and neck 60 ~75 gy with conventional split external irradiation .There were 22 cases combining with chemotherapy （ PBF or PFA program from 3 to 5 cycles）.There were 7 cases having nasopharynx and neck recurrence and 3 cases having simple neck recurrence af-ter radiotherapy .The average 5-year survival rate was 73.6%, stage II 88.2%and stage III/IV 66.7%.Distant metastasis was found in 11 patients （20.8%）, including lung metastases in 3 cases, systemic multiple bone metastases in 6 cases and liver metastases in 2 cases.Their mean survivals were less than 5 years.Radiotherapy sequelas included dental caries （18.0%）, neck soft tissue fibrosis （18.0%）, memory loss （13.6%）, hearing loss （9.0%）, growth retardation （9.0%）, trismus （4.5%） or unclear voice （4.5%）.Conclusion Children and adolescents with nasopharyngeal carcinoma have characteristics of low incidence , later stage of disease and better prognosis .Radiation therapy has a good effect and a high percentage of early radiation reactions .Distant metastasis could happen if treatment was failure .A better outcome could be obtained if further appropriate treatment is taken . {URL}：

关 键 词：鼻咽癌 放射治疗 儿童及青少年 预后 

分 类 号：R739.63[医药卫生—肿瘤] R815[医药卫生—临床医学]