鼻咽癌放疗后残存病灶分次立体定向放疗单中心Ⅱ期临床研究  

Fractionated stereotactic radiotherapy:single-center stage Ⅱ clinical study on the residual lesions of nasopharyngeal carcinoma

作　　者：吴伟莉[1] 金风[1] 龙金华[1] 李媛媛[1] 罗秀玲[1] 麻发强[1] 翁克贵[1] 

机构地区：[1]贵州医科大学附属医院.贵州省肿瘤医院头颈肿瘤科,贵州贵阳550001

出　　处：《中华肿瘤防治杂志》2015年第20期1624-1627,1633,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的鼻咽癌首程二维放疗后鼻咽局部仍有残存，常规放疗因技术限制及对正常组织的保护使推量受限，疗效不显著，本研究应用分次立体定向放疗（fractionated stereotactic radiotherapy,FSRT）治疗鼻咽癌根治性放疗后鼻咽残存病灶，评价远期疗效及毒副作用。方法选择1997—07-01—2002—10—31我科收治的54例鼻咽癌常规放疗后鼻咽局部残存患者，采用FSRT技术推量治疗。Ⅱ期12例，Ⅲ期30例，ⅣA期8例，ⅣB期4例；鼻咽残存病灶FSRT治疗总剂量18～24Gy，分3～4次／2周，1～3个中心，70％～90％参考剂量曲线。结果中位随访180个月，完全缓解率为63．0％，部分缓解率为37．0％。3年总生存率（overall survival，OS）为85．2％，5年为77．8％，10年为64．8％，13年为60．7％，15年为54．3％。3年局部无复发生存率（local relapse-free survival,LRFS）为98．1％，5年为95．8％，10年为86．3％，13年为83．4％，15年为83．4％。3年无进展生存率（progression-free survival，PFS）为83．3％，5年为75．9％，10年为59．1％，13年为55．1％，15年为55．1％。3年无远处转移生存率（distant metastasis survival，DMFS）为85．0％，5年为81．0％，10年为70．9％，13年为70．9％，15年为70．9％。死亡23例，其中13例死于远处转移，3例死于鼻咽局部复发，2例死于鼻咽及颈部淋巴结复发，2例死于颈部淋巴结复发，2例死于鼻咽大出血，1例死于心脏疾病。Cox多因素分析结果显示，年龄、N分期影响OS、LRFS、PFS、DMFS、临床分期和FSRT总剂量影响LRFS，FSRT总剂量影响PFS。3例出现听力一侧丧失，为FSRT治疗同侧；2例出现声音嘶哑，为FSRT治疗同侧；2例出现一侧斜视，为FSRT治疗同侧；2例出现吞咽困难、饮水呛咳；2例出现明显头痛。结论FSRT在鼻咽癌常规放疗后残存病灶治疗有一定的临床价值，局控率较高，损伤较小，并发症较少OBJECTIVE Nasopharyngeal carcinoma is still remaining after radiotherapy in patients with nasopharyngeal local, because of technical limitations and the protection of normal tissue. Conventional radiotherapy make the limited quantity, and curative effect is not significant. This study is to analyze the long-term effect and complications of fractionated stereotactic radiotherapy （FSRT） on residual lesions in nasopharynx cancer （NPC） patients, evaluating its value of clinical applications. METHODS Between July 1997 and October 2002, FSRT was performed in 54 patients with residual nasopharyngeal carcinoma after conventional fractionation. They all had comparatively complete follow-up data. The total administration dosage was 18-24 Gy in median single fractions of 6-8 Gy. All patients were received follow-ups with a median follow-up time of 13.5 years （ranging from 10.25 to 15.5 years）. The curative effect was evalu ated according to the WHO standard. RESULTS FSRT was well tolerated in all patients. The complete remission rate （CR） was 63.0%, and partial remission rate was 37.0%. The 3, 5, 10, 13, 15-year overall survival （OS） rates were 85.2% ,77.8% ,64.8% ,60.7%,54.3%, respectively. The 3, 5, 10, 13, 15-year local recurrence-free survival （LRFS） rates were 98.1%, 95.8%, 86.3%, 83.4%, 83.4%, respectively. The 3, 5, 10, 13, 15-year progression-free survival （PFS） rates were 83.3%, 75.9%, 59.1%, 55.1%, 55.1%, respectively. The 3, 5, 10, 13, 15-yeardistant metastasis-free survival （DMFS） rates were 85.0%, 81.0%, 70.9%, 70.9%, 70.9% respectively. Twenty-three patients died during the study period. The Cox analysis showed that age, N stage were the prognostic factors for OS, LRFS, PFS, and DMFS. Clinical stage and the total administration dosage of FSRT were the prognostic factors for LRFS. The total administration dosage of FSRT were the prognostic factors for PFS. CONCLUSION FSRT has better clinical value for the treatment of residual lesions after conventional fractionation with high LR

关 键 词：鼻咽肿瘤 残存病灶 放射治疗 分次立体定向放疗 预后 

分 类 号：R739.63[医药卫生—肿瘤]