【摘要】 目的研究单纯超分割后加速放疗对Ⅰ~Ⅱ期鼻咽癌局部控制、生存的影响和并发症状况。方法全组88例鼻咽癌患者于1995年12月至1998年4月行首次单纯放疗,鼻咽原发灶采用60Coγ线或6MV X线外照射,其中前4周采用超分割1.2Gy/次,2次/天,间隔≥6小时,5天/周,剂量为48Gy分40次;后2周采用加速超分割1.5Gy/次,2次/天,间隔≥6小时,5天/周,剂量为30Gy分20次,全疗程的总剂量为78Gy分60次6周完成。结果急性黏膜反应中鼻咽黏膜反应0级2例,1级22例,2级38例,3级24例,4级2例。T1、T2期鼻咽5年局部控制率分别是97.1%、93.9%(χ2=0.004,P=0.952)。Ⅰ期、Ⅱ期的5年生存率分别是87.5%、86.1%(χ2=0.195,P=0.659),N0、N1的5年远处转移率分别为6.2%、15%(χ2=3.982,P=0.046),颅神经损伤13.6%。结论鼻咽癌超分割后加速能使T2、Ⅱ期的5年局部控制率和生存率较高,与T1、Ⅰ期相比无明显下降,同时未增加后期并发症。N1的远程转移率较N0高,可考虑在该组患者中合用全身化疗。更多还原

【Abstract】 Purpose To follow up the efficacy and radiation-induced complications of late course accelerated fractionation(LCAF) radiotherapy in stageⅠ-Ⅱ nasopharyngeal carcinoma(NPC). Methods From December 1995 to April 1998,88 NPC patients with stageⅠand Ⅱ were admitted for radiation treatment.The radiation beam used was 60Co γ or 6 MV X-ray.For the first two-thirds of the treatment,two daily fractions of 1.2 Gy were given to the primary lesion,with an interval of ≥6 hours,5 days per week to a total dose of 48 Gy/40 fractions,over a period of 4 weeks.For the last one third of the treatment,i.e.,beginning from the 5th week,an accelerated hyperfractionation schedule was carried out.The dose per fraction was increased to 1.5 Gy,2 fractions per day with an interval of≥6 hours,the total dose for this part of the protocol was 30 Gy/20 fractions over 2 weeks.Thus the total dose was 78Gy in 60 fractions in 6 weeks. Results All patients completed the treatment.Acute mucositis: none in 2 patients,Grade 1 in 22,Grade 2 in 38,Grade 3 in 24,and Grade 4 in 2 patients.The 5-year nasopharyngeal local control rate in T1 and T2 stage were 97.1% and 93.9% separately(χ2=0.004,P=0.952),5-year survivals in Ⅰand Ⅱstage were 87.5% and 86.1%(χ2=0.195,P=0.659),the 5-year distant metastasis rate in N0 and N1 was 6.2% and 15%(χ2=3.982,P=0.046).Twelve patients had radiation-induced cranial nerve palsy. Conclusions With this treatment schedule,patient′s tolerance is good.Five-year local control and survival rate in T2 and Ⅱstage are almost the same as in T1 and Ⅰstage.Patients with N1 had a relatively higher distant metastasis rate,chemotherapy may be indicated for those patients.Radiation-related late complication does not increase.更多还原