【摘要】 背景与目的:下咽鳞癌放射治疗靶区是否需对整个鼻咽部进行预防照射存在争议。本研究的目的旨在探讨下咽鳞癌是否需要常规预防照射鼻咽部的临床意义。方法:回顾性分析1994年5月至2006年8月中山大学肿瘤防治中心收治的196例下咽鳞癌患者的临床资料。TNM分期,Ⅰ期3例,Ⅱ期26例,Ⅲ期38例,Ⅳ期129例。全组患者均接受以手术或/和放疗为主的治疗,其中放射治疗94例,手术治疗49例,放疗与手术综合治疗53例。按接受放疗的靶区分为鼻咽部预防照射患者78例和鼻咽部未预防照射患者69例,比较其治疗疗效。结果:全组患者3年及5年总生存率分别为38.57%和21.69%,Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者5年总生存率分别为100%、43.08%、27.57%和13.99%。单纯手术和放疗的患者5年总生存率分别为13.90%和10.60%,综合治疗的患者5年总生存率为44.08%。鼻咽部预防照射和未预防照射的患者5年生存率分别为24.44%和20.68%(χ2=0.10,P=0.76),5年无进展生存率分别为15.99%和10.91%(χ2=0.65,P=0.42),两者之间的差异均无统计学意义。全组39例患者颈部淋巴结复发,未随访到鼻咽部复发。鼻咽部预防照射和未预防照射的患者复发率和远处转移率之间的差异无统计学意义(χ2=1.56,P=0.21)。结论:晚期下咽鳞癌的治疗模式需手术联合放射治疗;对于下咽鳞癌原发灶的照射,不需要常规对鼻咽部进行预防照射,积极处理颈部淋巴结可能有助于改善患者生存。更多还原

【Abstract】 Background and Objective: There is controversy in whether the nasopharynx should be included in target volume for radiotherapy of hypopharyngeal squamous cell carcinoma. This study was to analyze the necessity of radiotherapy including the nasopharynx for patients with hypopharyngeal squamous cell carcinoma. Methods: Clinical data of 196 patients with hypopharyngeal squamous cell carcinoma treated in Cancer Center of Sun Yat-sen University from May 1994 to August 2006 were analyzed. Of the 196 cases of hypopharyngeal carcinoma, three were at stage Ⅰ, 26 at stage Ⅱ, 38 at stage Ⅲ, and 129 at stage Ⅳ. Ninety-four patients received radiotherapy, 49 received surgery and 53 received surgery combined with radiotherapy. The nasopharynx was included in target volume in 78 patients, but excluded in 69 patients. The prognosis of the two groups were compared. Results: The 3-year and 5-year overall survival rates were 38.57% and 21.69% . The 5-year survival rates were 100% in stage Ⅰ patients, 43.08% in stage Ⅱ patients, 27.57% in stage Ⅲ patients, and 13.99% in stage Ⅳ patients, and were 13.90% in surgery group, 10.60% in radiotherapy group, and 44.08% in combined therapy group. Between nasopharynx-included and nasopharynx-excluded groups, there was no significant difference in 5-year overall survival rate (24.44 % vs. 20.68%, χ2=0.10,P=0.76),5-year progression-free survival rate (15.99% vs. 10.91%, χ2=0.65, P=0.42), relapse rate and metastasis rate (χ2=1.56, P=0.21). Relapse in cervical lymph nodes occurred in 39 patients; no relapse in the nasopharynx was observed. Conclusions: Combined therapy is recommended for advanced hypopharyngeal squamous cell carcinoma. The target volume including the nasopharynx is not recommended. Controlling cervical lymph node metastasis may be helpful for prolonging survival.更多还原