鼻咽癌IMRT放射性溃疡临床及剂量因素分析  

An analysis of clinical and dosimetric factors for postradiation nasopharyngeal necrosis in intensity-modulated radiotherapy for nasopharyngeal carcinoma

作　　者：尹珍珍[1] 高黎[1] 罗京伟[1] 易俊林[1] 黄晓东[1] 王凯[1] 曲媛[1] 张世平[1] 李素艳[1] 肖建平[1] 徐国镇[1] 

机构地区：[1]国家癌症中心/北京协和医学院中国医学科学院肿瘤医院放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2016年第5期438-442,共5页Chinese Journal of Radiation Oncology

摘　　要：目的通过分析鼻咽癌初程IMRT后发生鼻咽溃疡的临床特点、预后及放疗剂量学等资料，了解与放射性鼻咽溃疡发生的相关因素。方法回顾分析2001-2013年接受初程IMRT的鼻咽癌患者共1217例，结合临床症状、腔镜、MRI及病理（除外局部复发）诊断放射性鼻咽溃疡共21例，总结其临床特点、预后情况，并复阅其放疗计划进行剂量学评估。结果21例放射性溃疡患者中男17例、女4例；T2期1例、T3期3例、T4期17例。GTVnx中位数83cm^3，除1例T2期病变PGTVnx处方剂量为69．96Gy外，余20例处方剂量为73．92Gy。鼻咽溃疡发生时间为放疗结束后1．8-21．9个月（中位数6．2个月），鼻咽部大出血发生率为48％（10／21）。21例患者中6例溃疡愈合，15例持续不愈．其中8例死亡（鼻咽大出血4例、恶液质及伴多器官功能衰竭3例、多发骨转移1例）。结论放射性鼻咽溃疡是鼻咽癌IMRT后严重不良反应之一,其发生与T分期晚、肿瘤体积大、营养状态差、感染、放疗剂量及高强度治疗等有关。鼻咽大出血与恶液质为此类病例的主要死亡原因。Objective To investigate the influencing factors for postradiation nasopharyngeal necrosis （PRNN） by analyzing clinical characteristics, prognosis, and dosimetry of PRNN after initial intensity-modulated radiotherapy （IMRT） for nasopharyngeal carcinoma （NPC）. Methods A retrospective analysis was performed among 1217 patients with NPC who received initial IMRT from 2001 to 2013. Twenty- one patients were diagnosed with PRNN by clinical symptoms, endoscopy, magnetic resonance imaging, and pathological evidence （not including local recurrence ）. The clinical characteristics and prognosis were summarized and the radiotherapy plans were reassessed for dosimetrie evaluation. Results In the 21 patients with PRNN, 17 were male and 4 female;one patient was in stage T2 , 3 in stage T3 , and 17 in stage T4. The median volume of gross tumor was 83 cm3. All patients received radiotherapy with a prescribed dose of 73.92 Gy except one patient with stage T2 disease who received a prescribed dose of 69.96 Gy. The time to PRNN after radiotherapy ranged between 1.8 and 21.9 months （ median time = 6. 2 months）. The incidence of massive nasopharyngeal bleeding was 48% （ 10/21 ）. In the 21 patients, 6 recovered form PRNN, 15 remained ill, and 8 patients died, consisting of 4 who died of massive nasopharyngeal bleeding, 3 of caehexia with multiple organ failure, and 1 of multiple bone metastases. Conclusions PRNN is one of the severe adverse reactions after IMRT for NPC. The development of PRNN is related to advanced T stage, large tumor volume, poor nutritional status, infection, radiotherapy dose, and intense treatment. Massive nasopharyngeal bleeding and cachexia are the primary causes of death in patients with PRNN.

关 键 词：鼻咽肿瘤/三维放射疗法 放射性鼻咽坏死 因素分析 

分 类 号：R739.63[医药卫生—肿瘤]