局部复发鼻咽癌超分割IMRT的临床分析  

Efficacy of intensity-modulated radiotherapy on patients with locally recurrent nasopharyngeal carcinoma

作　　者：尹丽[1] 郭文杰[1] 解鹏[1] 朱焕锋[1] 严鹏伟[1] 吴婧[1] 宋丹[1] 吴建峰[1] 王飞江[1] 何侠[1] 

机构地区：[1]南京医科大学附属江苏省肿瘤医院放疗科,南京210009

出　　处：《中华放射肿瘤学杂志》2016年第9期917-922,共6页Chinese Journal of Radiation Oncology

基　　金：江苏省科技厅临床医学科技专项基金（BL2014091）

摘　　要：目的分析LR鼻咽癌行再程超分割IMRT的临床疗效和不良反应。方法2011--2015年间28例接受超分割IMRT患者人组，中位复发时间为17．5个月，其中男23例、女5例，年龄25～74岁。肿瘤局部剂量60～70Gy，1．2Gy!次，2次／d，间隔6h以上，每周连续治疗5d。25例患者同期接受了奈达铂单药或联合方案化疗，4例接受了今又生p53基因治疗，6例接受EGFR单抗靶向治疗。结果超分割IMRT后3个月，CR、PR率分别为89％（25／28）、11％（3／28）。中位随访27．5个月．1，2，3年OS、LRFS、PFS分别为100％、91％、80％，100％、80％、55％，88％、65％、55％。3例患者治疗后出现3级鼻咽黏膜溃疡坏死，经对症处理后好转。多因素分析PFS预后不良因素包括肿瘤分期rT3-T4期（P=0．00）、无化疗（P=0．04）。结论超分割IMRT对复发鼻咽癌有良好的Lc效果，不良反应可控．值得临床推荐试用。Objective This study retrospectively analyzed the efficacy and toxicity profile of hyperfractionated intensity-modulated radiotherapy （HF-IMRT） for locally recurrent nasopharyngeal carcinoma （NPC）. Methods Twenty-eight locally recurrent patients of NPC were enrolled,23 male and 5 female with a median of 51 years （range 25-74 years）. All patients had a median recurrent time of 17. 5 months and received HF-IMRT with a total dosage of 60-70 Gy, each consisting of 1.2 Gy per fraction, each of the 2 fractions were spaced 6 hours apart and lasting for 5 days. Twenty-five patients received concurrent chemotherapy of nedaplatin or two agent regimen,4 patients received Ad-p53 gene therapy and 6 patients received target therapy of EGFR monoclony antibody. Results The complete response and partial response rates were 89% （25/28） and 11% （3/28） after being treated by HF-IMRT for 3 months. The median follow- up time was 27.5 months. The 1,2,3-year overall survival rates, locoregional recurrence-free survival rates and progression-free survival rates were 100%, 91%, 80% ; 100%, 80%, 55% ; 88%, 65%, 55%, respectively. Three patient were observed to develop severe nasopharyngeal necrosis but recover after treatment, no patients experienced hemorrhage of nasopharynx. Multivariate analysis indicated that the poor prognostic factors included tumor stages （T3-T4） （P=0. 00） and no chemotherapy （P=0. 04）. Conclusion HF-IMRT is feasible for locally recurrent nasopharyngeal carcinoma with satisfactory local control and controllable adverse reaction, it is worth further clinical studies.

关 键 词：肿瘤复发 鼻咽/放射疗法 放射疗法 超分割 放射疗法 调强 治疗结果 不良反应 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]