454例鼻咽癌IMRT±化疗远期疗效及影响因素分析  

Long-term efficacy of intensity-modulated radiotherapy with or without chemotherapy in treatment of nasopharyngeal carcinoma and its influencing factors：an analysis of 454 patients

作　　者：龙金华[1] 金风[1] 吴伟莉[1] 李媛媛[1] 陈潇潇[1] 龚修云[1] 麻发强[1] 戚正君[1] 

机构地区：[1]贵阳医学院附院肿瘤科 贵州省肿瘤医院头颈肿瘤科,550004

出　　处：《中华放射肿瘤学杂志》2015年第6期659-662,共4页Chinese Journal of Radiation Oncology

摘　　要：目的：对454例鼻咽癌IMRT ±化疗的远期疗效及影响因素分析。方法回顾分析本中心2007—2012年采用IMRT ±化疗的454例无远处转移鼻咽癌患者资料。放疗处方剂量：鼻咽大体肿瘤69．96～73．92 Gy分33次，颈部转移淋巴结69．96 Gy分33次，高危引流区60．06 Gy分33次，低危引流区50．96 Gy分28次。诱导化疗438例，同期化疗420例，辅助化疗216例，顺铂、紫杉醇为主。Kaplan？Meier法计算生存并Logrank 法检验和单因素预后分析， Cox法多因素预后分析。结果3年样本数为210例，3年OS、LRFS、NRFS、PFS、DMFS分别为88．1％、91．0％、90．7％、80．5％、85．1％。影响OS因素有年龄（ P＝0．011）、T分期（ P＝0．005）、N分期（ P＝0．033）；T、N分期对DPFS （ P＝0．017、0．005）、DMFS （ P＝0．012、0．019）均有影响。≥3级急性及晚期不良反应主要为血液学、口腔黏膜反应，口干、吞咽困难和脑损伤。结论 IMRT提高了鼻咽癌患者长期生存，远处转移是主要失败原因， IMRT联合化疗不良反应能耐受。Objective To analyze the long？term efficacy of intensity？modulated radiotherapy （IMRT） with or without chemotherapy in treatment of 454 patients with nasopharyngeal carcinoma （NPC） and its influencing factors. Methods A retrospective analysis was performed on the clinical data of 454 patients with non？metastatic NPC who received IMRT with or without chemotherapy in our center from 2007 to 2012. Prescribed doses of 69. 96？73. 92 Gy in 33 fractions, 69. 96 Gy in 33 fractions, 60. 06 Gy in 33 fractions, and 50. 96 Gy in 28 fractions were applied to nasopharyngeal gross tumor volume, cervical metastatic lymph nodes, high？risk drainage area, and low？risk drainage area, respectively. In all patients, 438 received induction chemotherapy, 420 concurrent chemotherapy, and 216 adjuvant chemotherapy, most of which were based on cisplatin and taxol. The Kaplan？Meier method was used for calculating survival rates and the log？rank test was used for survival difference analysis and univariate prognostic analysis. The Cox model was used for the multivariate prognostic analysis. Results The 3？year sample size was 210. The 3？year overall survival （ OS ） , local recurrence？free survival, nodal relapse？free survival, progression？free survival, and distant metastasis？free survival （ DMFS） rates were 88. 1%, 91. 0%, 90. 7%, 80. 5%, and 85. 1%, respectively. Age, T stage, and N stage were influencing factors for the OS rate （ P=0. 011;P=0. 005;P=0. 033）;T stage and N stage were influencing factors for the disease progression？free survival （ P=0. 017;P=0. 005） and DMFS （ P=0. 012;P=0. 019） . The grade≥3 acute and late adverse reactions included hematological toxicity , oral mucositis , xerostomia , dysphagia , and brain injury . Conclusions IMRT promotes the long？term survival rates in patients with NPC. The distant metastasis is the major reason for treatment failure. The adverse reactions induced by IMRT combined with chemotherapy are tolerable.

关 键 词：鼻咽肿瘤/放射疗法 放射疗法 调强 预后 

分 类 号：R739.63[医药卫生—肿瘤]