【作者】 李瑞英； 高秋玲； 庞青松； 刘淑艳； 王平；

【Author】 Li Rui-Ying Gao Qiu-Ling Pang Qing-Song Liu Shu-Yan Wang Ping Department of Radiation Oncology, Tianjin Cancer Hospital, Tianjin Medical University, Tianjin, 300060

【机构】 天津医科大学附属肿瘤医院放疗科；

【摘要】 目的:探讨新型鼻咽癌施源器的临床应用疗效及副反应。方法:前瞻性临床研究本院1997年至2005年间的住院鼻咽癌T1～T3患者66例,接受外照射联合腔内后装治疗,所有患者均经影像学CT或MRI检查及病理确诊,临床分期按 1992年福州分期标准,66例患者中I期2例,II期30例,III 期24例,IV期8例,T1 20例,T2 33例,T3 11例。2例患者为局部复发。治疗方法为面颈联合野加耳前野外照射剂量55～70 Gy,后追加腔内后装治疗5～24 Gy,部分病人接受了颈部转移淋巴结微波加热治疗及放疗前后的全身化疗。同时,分析2例局部复发鼻咽癌患者采用腔内后装治疗的疗效。结果:随访至2006年5月1日,随访3～99个月(中位随访期50．7月),随访率90%。13例局部复发,13例远处转移。近期局部有效率(CR+PR)94％。用Kaplan—Meier分析法生存分析显示,1,3,5年总生存率OS分别为92．7％、 85．2％、81．6％。1,3,5年无复发生存率RFS分别为 89．7％、81．23%、77．0％。1,3,5年无转移生存率MFS分别为91．5％、84．0％、73．2％。1,3,5年无病生存率DFS 分别为86．6％、78．8％、64．8％。Cox回归模型分析,显示仅T分期对生存率有影响,而患者性别、年龄,病理、N分期均对生存率无影响。发生远期放疗并发症:颞叶损伤1例, 听力损伤1例,无一例发生张口困难并发症。且特制的新型一体双管施源器,提高鼻咽局部剂量的同时,降低软腭剂量, 无一例患者发生软腭穿孔并发症。2例局部复发鼻咽癌接受腔内后装治疗后,局部疗效达CR,复发后分别随访12个月及9年,至今仍然无病生存。结论:对鼻咽癌行外照射加新型鼻咽癌施源器腔内后装治疗,能取得较好的局部疗效和生存率,同时降低外照射剂量,减少放疗并发症,而福州分期尤其是T分期越早,则疗效越好。同时,对局部复发鼻咽癌患者,应用该新型鼻咽癌施源器后装治疗可以取得较好的疗效。更多还原

【Abstract】 Objective: To investigate the clinical effect and side effect of a new applicator design for intracavity brachytherapy of nasopharyngeal carcinoma. Methods: From 1997 to 2005,66 patients with T1 - T3 nasopharyngeal carcinoma were prospectiveiy treated with external beam radiotherapy plus intracavity brachytherapy All the patients were diagnosed by CT/ MRI and pathology. According to the 1992 Fuzhou TNM staging system, there were 2 cases in stage I,30 in stage II, 24 in stage III, 8 in stage IV,and 20 T1 stage, 33 T2 stage, 11 T3 stage, the other 2 were local recurrence patients.55 Gy - 77 Gy were applied by external beam radiotherapy, followed by a boost of 5 -24 Gy by brachytherapy. Some patients also received hyperthermotherapy of cervical lymphanode and adjuvant chemotherapy. The clinical effect of the 2 local recurrence patients treated with brachytherapy were also analyzed . Results: With a median follow-up of 50.7 months(3 -99 months).13 patients developed local recurrence, and 13 patients developed distant metastasis. Recent local regional control rate (CR+PR) was 94%.Kaplan-meier analysis showed that the 1,3,5-year overall survival rate were 92.7 %,85.2%,81.6% respectively, and the 1,3,5-year relapse-free survival rate were 89.7%,81.23%,77.0% respectively, the 1,3,5-year metastasis-free survival rate were 91.5%, 84.0%, 73.2% respectively, the 1,3,5-year disease-free survival rate were 86.6%,78.8%,64.8%. Cox regression model was used to analyze prognostic factors ,univariant analysis showed that only T stage had prognostic significance. The differences in sex, age, pathology and N stage were not significant. The late radiation effects were observed as follows: 1 patient developed hearing loss ,and no patients developed difficulty in opening mouth or perforation in soft palate.2 patients with local recurrence nasopharyngeal carcinoma received intracavity brachytherapy had achieved complete response effect, and after a follow-up of 12 months and 9 years ,they were still alive with disease-free. Conclusion: The local control rate and survival rate of nasopharyngeal carcinoma treated with external beam radiotherapy plus intracavity brachytherapy with the new applicator were satisfactory ,and radiation side effects were diminished .T stage was valuable prognostic factor. The new applicator for local recurrence nasopharyngeal carcinoma also achieved significant effect.更多还原