【摘要】 [目的]研究鼻咽癌调强放射治疗(IMRT)的投照方式、近期临床疗效,以及单纯放疗和放、化疗结合的耐受性。[方法]2003年12月￣2005年12月157例初治鼻咽癌患者鼻咽和全颈及锁骨上全程实施前7野IMRT。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)处方剂量分别为70Gy、66Gy、60Gy、50Gy,共32分次。88例患者行联合化疗。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]治疗计划结果显示,靶区内GTV1、GTV2、CTV1和CTV2的平均剂量分别为70.5Gy、67.0Gy、60.1Gy和51.2Gy。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%。放化综合治疗组的口咽、黏膜反应及血液系统毒性明显高于单纯放疗组。患者近期毒副反应均可以耐受,口干症状随着治疗后时间的延长逐渐减轻。[结论]IMRT使靶体积照射剂量提高,而周围器官受照剂量降低,对初治鼻咽癌可获得理想的局部区域控制,放化综合治疗对控制远处转移有一定价值。更多还原

【Abstract】 [Purpose] To study radiationfields and clinical efficacy of intensity modulated radiation therapy (IMRT), and the tolerance of radiotherapy alone and radio-chemotherapy in initially treated nasopharyngeal carcinoma (NPC). [Methods] From Dec. 2003 to Dec. 2005, 157 cases of initially treated nasopharyngeal carcinoma underwent full course IMRT including nasopharynx and full neck to supraclavicle with 7 front radiationfields in Jiangsu Cancer Hospital. The prescription dose was 70Gy/32f to gross target volume (GTV1) of nasopharyngeal to nasopharynx, 66Gy/32f to positive neck lymphnodes (GTV2), 60Gy/32f to clinical target volume1(CTV1), and 50.4Gy/28f to CTV2. Eighty-eight patients were treated with combination chemotherapy. Kaplan-Meier method was used for survival analysis, and acute and late toxicities were assessed according to RTOG radiation morbidity scoring criteria. [Results] The results of treatment plan showed that the mean dose of GTV1, GTV2, CTV1 and CTV2 were 70.5Gy, 67.0Gy, 60.1Gy and 51.2Gy respectively. The 1-, 2-year local-regional progression-free survival rates, distant metastases-free survival rates and overall survival rates were 97.4%, 94.9%; 93.6%, 89.4% and 96.4%, 92.7%, respectively with medion follow-up of 16 months. Toxicities of oropharynx, in ucosa, hematologic system in radio-chemotherapy group were higher than those in radiotherapy alone group. Short-term toxicities were tolerable, and xerostomia alleviated with time prolonged. [Conclusion] IMRT can improve the dose of target volume, decrease the dose of surrounding organs, and yield well local-regional control of cancer in initially treated NPC. Radiotherapy combined with chemotherapy is valuable for distant metastasis.更多还原