【作者】 何侠； 翟振宇； 宋丹； 张宜勤； 魏青； 黄生富； 李枫； 卞秀华；

【Author】 He Xia Zhai Zhen-Yu Song Dan Zhang Yi-Qin Wei Qin Huang Sheng-Fu Li Feng BianXiu-Hua Department of Radiation Oncology, Jiangsu Cancer Hospital, Nanjing 210009,China

【机构】 江苏省肿瘤医院放疗科；

【摘要】 目的:研究鼻咽癌调强放射治疗(IMRT)的投照方式、单放及放化结合的耐受性和近期临床疗效。方法:初治鼻咽癌患者157例中,I期9例,Ⅱ期32例,Ⅲ期84例,Ⅳa期32 例。单纯根治性放疗69例放化综合治疗88例。将鼻咽和颈部的靶体积划分为鼻咽大体肿瘤体积(GTV1)、颈部大体肿瘤体积(GTV2)、临床靶体积1(CTV1)和临床靶体积2(CTV2)。 GTV1、GTV2、CTV1、CTV2处方剂量分别为70、66、60、 50Gy,共32分次。鼻咽和全颈及锁骨上全程实施前7野IMRT 技术照射。采用Kaplan—Meier法进行生存分析,RTOG标准评价急性反应和晚期损伤。结果:中位随访时间16个月,1、 2年局部区域无进展和无远处转移生存率及总生存率分别为 97．4％、94．9％和93．6％、89．4％及96．4％、92．7％。患者近期毒副反应可以耐受,口干症状随着治疗后时间的延长口干逐渐减轻。IMRT使靶体积照射总剂量和分次剂量提高,而危及器官受照总剂量和分次剂量降低。结论: IMRT初治鼻咽癌可获得理想的局部区域控制,对正常组织器官有较好的保护作用;放化综合治疗对控制远处转移有一定价值。更多还原

【Abstract】 Objective: To study radiationfields,toler-ate of radiationtherapy or combined chemotherapy ,clini-cal efficacy of intensity modulated radiation therapy (IMRT) for first-treated nasopharyngeal carcinoma. Methods: Between Dec 2003 and Dec.2005,157 patients of first-treated nasopharyngeal carcinoma underwent IMRT at the Jiangsu Cancer Hospital. According to the Fuzhou Staging Classification, 9 patients had stage_,32 stage II ,84 stage III,and 32 stage IV. The prescription dose was engaged to the gross target volume (GTV1) of nasopharyngeal to DT 70Gy/32f, positive neck lymphnodes (GTV2) to DT66Gy/32f,clinical target volumel(CTVl) to 60Gy/32f, and CTV2 to S0Gy/28f. All of the first-treated nasopharyngeal carcinoma were treated with 7 front radiationfields for full course IMRT including nasopharynx and full neck to supraclavicle. Kaplan-Meier method was to calculate the local-regional progression-free rate,distant metastasis-free rate, and overall survival. Acute and late toxicities were graded according to RTOG radiation morbidity scoring criteria. Results: The Results of treatment plan showed that the mean dose of GTV1, GTV2, clinical targe volume CTV1 and CTV2 in the targes were 70.5Gy,67Gy, 60.1Gy and 51.2Gy. The 1-, 2- year estimated local-regional progression-free survival rates, distant metastases-free survival rates and overall survival rates was 97.4%, 94.9%,93.6%,89.4% and 96.4%,92.7%.Xerostomia could be tolerate ang decreased with time. IMRT can improved the total dose and dose perfraction to the target volume with significant sparing of the normal structures at the sametime.Conclusion: IMRT yields well dose distribution and acceptable toxity in first-treated nasopharyngeal carcinoma.Radiationtherapy combined with chemotherapy is effecious to control distant metastasis.更多还原