大分割伽马刀与大分割适形再程放疗治疗局部复发鼻咽癌的对比研究  

Contrastive study on the treatment of locally recurrent nasopharyngeal carcinoma with large segmentation gamma knife and large segmentation conformal retransmission radiotherapy

作　　者：龙斌[1] 刘利民[1] 周光华[1] 施晓焱 龙君 Long Bin;Liu Limin;Zhou Guanghua;Shi Xiaoyan;Long Jun(Department of Oncology,the 163rd Hospital of PLA,the Second Affiliated Hospital of Hunan Normal University,Changsha 410003,China)

机构地区：[1]解放军第一六三医院湖南师范大学第二附属医院肿瘤科,长沙410003 [2]解放军第一六三医院湖南师范大学第二附属医院特诊科,长沙410003

出　　处：《中国医师进修杂志》2018年第9期779-786,共8页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 比较大分割伽马刀与大分割适形再程放疗治疗局部复发鼻咽癌的疗效和不良反应.方法 选取2009年1月至2012年6月收治局部复发鼻咽癌患者121例,倾向性得分匹配法分为大分割适形再程放疗组（对照组,61例）和大分割伽马刀再程放疗组（研究组,60例）.观察放射损伤、生命质量影响、近期疗效及远期疗效等.结果 近期放射损伤,研究组颌面部皮肤反应和乏力发生率明显高于对照组[28.3％（17/60）比13.1％（8/61）和48.3％（29/60）比29.5％（18/61）],差异有统计学意义（P〈0.05）;两组口干和口腔黏膜损伤发生率比较差异无统计学意义（P〉0.05）.远期放射损伤,研究组耳聋和张口困难发生率明显低于对照组[33.3％（20/60）比52.5％（32/61）和58.3％（35/60）比73.8％（45/61）],而颌面部肌肉纤维化发生率明显高于对照组[43.3％（26/60）比26.2％（16/61）],差异有统计学意义（P〈0.05）;两组口干和放射性脑病发生率比较差异无统计学意义（P〉0.05）.实际远期放射损伤,研究组口干、耳聋和张口困难发生率明显低于对照组[66.7％（40/60）比86.9％（53/61）、31.7％（19/60）比50.8％（31/61）和43.3％（26/60）比67.2％（41/61）],而颌面部肌肉纤维化发生率明显高于对照组[41.7％（25/60）比23.0％（14/61）],差异有统计学意义（P〈0.01或〈0.05）;两组放射性脑病发生率比较差异无统计学意义（P〉0.05）.两组治疗前与治疗结束时及治疗结束时与治疗后3个月KPS评分、体质量变化比较差异无统计学意义（P〉0.05）.近期疗效,研究组治疗后3、6、9和12个月局部控制率明显高于对照组[75.0％（45/60）比54.1％（33/61）、86.7％（52/60）比62.3％（38/61）、90.0％（54/60）比67.2％（41/61）和91.7％（55/60）比68.9％（42/61）],差异有统计学意义（P〈0.05）.远期疗效,两组1、2、3、4和5年生存率比较差异无统计学意�Objective To compare the efficacy and adverse reactions of large segmentation gamma knife and large segmentation conformal retransmission radiotherapy for locally recurrent nasopharyngeal carcinoma. Methods One hundred and twenty- one patients with locally recurrent nasopharyngeal carcinoma from January 2009 to June 2012 were selected. The patients were divided into large segmentation conformal retransmission radiotherapy group （control group, 61 cases） and large segmentation gamma knife retransmission radiotherapy group （study group, 60 cases） according to the propensity score matching method. The radiation injury, quality of life, short-term efficacy and long-term efficacy were observed. Results In the recent radiation injury, the incidences of maxillofacial skin reaction and fatigue in study group were significantly higher than those in control group： 28.3% （17/60） vs. 13.1% （8/61） and 48.3% （29/60） vs. 29.5% （18/61）, and there were statistical differences （P〈0.05）;there were no statistical differences in the incidences of dry mouth and oral mucosal injury between 2 groups （P〉0.05）. In the long-term radiation injury, the incidences of deafness and difficulty in opening mouth in study group were significantly lower than those in control group： 33.3% （20/60） vs. 52.5%（32/61） and 58.3% （35/60） vs. 73.8% （45/61）, the incidence of maxillofacial muscle fibrosis in control group was significantly higher than that in control group： 43.3% （26/60） vs. 26.2% （16/61）, and there were statistical differences （P〈0.05）; there were no statistical differences in the incidences of dry mouth and radiation encephalopathy between 2 groups （P〉0.05）. In the actual long- term radiation injury, the incidences of dry mouth, deafness and difficulty in opening mouth in study group were significantly lower than those in control group： 66.7% （40/60） vs. 86.9% （53/61）, 31.7% （19/60） vs. 50.8% （31/61） and 43.3% （26/60） vs. 67.2% （41/61）, th

关 键 词：鼻咽肿瘤 放射疗法 适形 Γ射线 辐射损伤 治疗结果 

分 类 号：R739.63[医药卫生—肿瘤]