放疗后残存、复发鼻咽癌的立体定向放射治疗  

Stereotactic Radiotherapy for Residual or Recurrent Nasopharyngeal Carcinoma

作　　者：钟军[1] 罗志强[1] 刘明之[1] 罗辉[1] 万桂芬[1] 叶新芊[1] 李国庆[1] 

机构地区：[1]江西省肿瘤医院,330029

出　　处：《实用癌症杂志》2003年第1期74-76,共3页The Practical Journal of Cancer

摘　　要：目的　评价对鼻咽癌患者放射治疗后局部残存、区域复发进行立体定向放射治疗的临床价值和毒副作用。方法　对3 3例鼻咽癌放射治疗后局部残存、区域复发的患者 ,应用大恒公司生产的立体定向放射治疗系统 ,6MVX线 ,60 %～ 90 %为参考剂量曲线 ,肿瘤边缘分次剂量为 3～ 8Gy(中位数 :6Gy) ,间隔 1～ 2天 ,总剂量为 12～ 48Gy(中位数 :3 1Gy) /3～ 13次 (中位数 :6次 )。靶体积为 4.2～ 45 .0cm3 (中位数 :18.7cm3 )。患者分为 3个组 :A组 11例为首程根治性放射治疗后 6个月内经鼻咽镜、CT或MRI检查发现仍有较大肿块残存 ;B组 13例为首程根治性放射治疗后 6个月以上区域复发者 ;C组 9例为根治性放射治疗后复发行二程放射治疗后 6个月以上再次复发者。结果　全部 3 3例患者CR为 5 4.5 % ,PR为 3 3 .3 % ,NC为 12 .1%。A组CR为63 .6% ,PR为 3 6.4% ,NC为 0。B组CR为 61.5 % ,PR为 2 3 .1% ,NC为 15 .4%。C组CR为 3 3 .3 % ,PR为 44 .4% ,NC为2 2 .2 %。A、B、C组 3年生存率分别为 72 .7% ,3 2 .3 % ,3 3 .3 %。鼻咽部大出血的发生率为 12 .1% (4 /3 3 )。结论　鼻咽癌放射治疗后局部残存、区域复发 ,采用立体定向放射治疗推量治疗或单一治疗是 1种有效的方法 。Objective To evaluate the clinical value and the side effect of fractionated stereotactic radiotherapy(FSRT) for residual or recurrent nasopharyngeal carcinoma.Methods During the period of July 1997 and July 2001,33 patients were treated by FSRT with 6 MV photons.60%～90% isodose curves covered lesion where the total FSRT dose were 12～48 Gy(Median:31 Gy)/3～13 f(Median:6 f) of fraction size 3～8 Gy(Median:6 Gy),with interfraction duration of 1～2 days.Lesion volumes from 4.2 to 45.0 cm 3(Median:18.7 cm 3).The patients were divided into three groups.Group A:11 patients with residual occurring less than 6 months after first standard radiotherapy.Group B:13 patients with recurrent occurring over 6 months after first standard radiotherapy.Group C:9 patients with recurrent occurring over 6 months after second standard radiotherapy.Results In all 33 patients:CR was 54.5%,PR 33.3% and NC 12.1%. In group A:CR 63.6%,PR 36.4% and NC 0.Group B:CR 61.5%,PR 23.1% and NC 15.4%.Group C:CR 33.3%,PR 44.4% and NC 22.2%.The 3 years survivals of the Group A,B,C was 72.7%,32.3% and 33.3% respectively.The incidence of nasopharyngeal massive hemorrhage was 12.1%.Conclusion Fractionated stereotactic radiotherapy(FSRT) is an effective treatment modality for residual or recurrent nasopharyngeal carcinoma at the primary focus.nasopharyngeal massive hemorrhage is the serious complication.

关 键 词：鼻咽肿瘤 放射疗法 立体定向放射治疗 预后 

分 类 号：R739.63[医药卫生—肿瘤]