鼻咽癌IMRT远期疗效和不良反应分析  

Long-term efficacy and adverse effects of intensity-modulated radiotherapy for nasopharyngeal carcinoma

作　　者：区晓敏[1] 史琪[1] 周鑫[1] 杨佑琦 邢星[1] 许婷婷[1] 沈春英[1] 王孝深[1] 孔琳[1] 何霞云[1] 应红梅[1] 胡超苏[1] 

机构地区：[1]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院放疗科,上海200032

出　　处：《中华放射肿瘤学杂志》2016年第4期304-309,共6页Chinese Journal of Radiation Oncology

基　　金：上海市科委基础研究重点项目（12 JC1402800）

摘　　要：目的：分析鼻咽癌IMRT的远期疗效和不良反应。方法将2009—2010年间869例病理诊断明确、无远处转移、接受全程IMRT的鼻咽癌患者纳入研究。84．8％接受以顺铂为基础化疗。鼻咽原发灶放疗66～70．4 Gy分30～32次，颈部阳性淋巴结66 Gy分30～32次。 Kaplan－Meier法计算生存率，Logrank法检验差异和单因素预后分析，Cox模型多因素预后分析。结果5年OS率为84．0％，5年LRFS、RRFS 、DMFS、DFS率分别为89．7％、94．5％、85．6％、76．3％。对局部晚期患者同期化疗有降低远处转移趋势（83．6％比75．7％，P＝0．050）和改善OS趋势（82．6％比77．0％，P＝0．082）。诱导化疗有提高OS趋势（80．7％比71．4％，P＝0．057），其中含多西他赛或吉西他滨的诱导化疗有提高OS趋势（83．3％比72．2％，P＝0．058）。初始放疗后接受推量者DFS率更低（52．2％比71．1％，P＝0．004）。同期化疗增加远期口干、张口困难，高剂量顺铂增加口干和听力损伤。结论 IMRT治疗鼻咽癌远期疗效较好。同期化疗联合IMRT有降低远处转移趋势，其价值需进一步研究。放疗后残留接受推量似乎与不良预后有关。化疗增加远期不良反应发生率。[Abstra ct] Objective To investigate the long-term efficacy and adverse effects of intensity-modulated radiotherapy （IMRT） for nasopharyngeal carcinoma （NPC）.Methods A total of 869 patients with biopsy-proven NPC without distant metastasis who underwent the whole course of IMRT from 2009 to 2010 were enrolled.Of all the patients, 84.8%received cisplatin-based chemotherapy.The prescribed dose to the primary lesion in the nasopharynx was 66-70Gy in 30-32 fractions, and the dose to the positive lymph nodes in the neck was 66 Gy in 30-32 fractions.The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for difference analysis and univariate prognostic analysis , and the Cox proportional hazards model was used for multivariate prognostic analysis .Rseu lts The 5-year overall survival（ OS ） , local recurrence-free survival, regional recurrence-free survival, distant metastasis-free survival, and disease-free survival （ DFS ） were 84.0%, 89.7%, 94.5%, 85.6%, and 76.3%, respectively.In the patients with locally advanced NPC,concurrent chemotherapy tended to reduce distant metastasis （83.6%vs.75.7%, P=0.050） and improve OS （82.6%vs.77.0 %, P=0.082）.Induction chemotherapy tended to improve OS （ 80.7% vs.71.4%, P=0.057 ） , and the induction chemotherapy containing docetaxel or gemcitabine tended to improve OS （83.3%vs.72.2%, P=0.058）.The patients who received a boost after the initial radiotherapy had a significantly lower DFS rate than those who did not （52.2%vs.71.1%, P=0.004）.The concurrent chemotherapy increased the incidence rates of long-term xerostomia and trismus, while a high dose of cisplatin increased the incidence rates of xerostomia and hearing impairment.Conclusions IMRT for NPC provides satisfactory long-term efficacy.Concurrent chemotherapy combined with IMRT tends to reduce the incidence of distant metastasis, and other values need further investigation.The boost therapy after radiotherapy may be associated with poor prognosis.Chemotherapy

关 键 词：鼻咽肿瘤/调强放射疗法 同期化疗 放疗推量 远期毒性 

分 类 号：R739.63[医药卫生—肿瘤]