鼻咽癌放射治疗的失败模式

The failure patterns of nasopharyngeal carcinoma treated by radiation therapy

目的分析鼻咽癌患者治疗失败模式及其与治疗前相关因素的关系,探求更好的治疗方案。方法自1990年1月1日至1999年5月30日收治首程治疗的患者905例。分析放射治疗后失败的模式及其影响因素。组间差别用χ2检验。结果254例首次治疗后出现失败,失败率为28.1%。5、10年局部控制率分别为81.7%、76.7%。首次治疗失败中局部失败104例,占失败患者的40.9%;远地转移124例,占失败患者的48.8%。79.5%的局部失败和88.6%远地转移出现在治疗后3年内。骨转移是最常见的部位,其次是肝和肺。1992年福州T、N分期和临床分期对局部失败的影响无显著性差异(P>0.05),对远地转移的影响有极显著性差异(P<0.01)。结论远地转移已成为鼻咽癌放射治疗失败的主要原因之一,如何降低T4、N3期患者的远地转移是当前面临的课题。

Objective To evaluate the failure patterns of nasopharyngeal carcinoma and the relationship between the failure pattern and pretreatment clinical stage. Methods From January 1990 to May 1999, 905 untreated cases were admitted into our hospital. we mainly analyze the incidence of local failure, distant failure, and relationship between the failure patterns and pretreatment parameters. Difference was evaluated using χ 2 test. Results Totally 254 (28.1%) patients who received radical radiotherapy failed in local regional recurrence and/or distant metastasis. The 5 ,10 year local regional control was 81.7% and 76.7% respectively. Among them, 104 cases failed in local regional recurrence, 124 failed in distant metastasis, 26 in both local regional recurrence and distant metastasis. 79.5% of local regional recurrence and 88.6% of distant metastasis occurred within 3 years after completion of the radiation treatment. Primary site recurrence was the most common site of local regional failure; bone metastasis was the most common site of distant metastasis, followed by liver and lung. The impact of 92' Fuzhou TNM staging system on the local regional failure showed that there was no significance difference among T and N stage. But the impact of 92' Fuzhou TNM staging system on distant metastasis was significant(P< 0.01 ). Conclusions Distant metastasis is one of the most common site of failure in the nasopharyngeal carcinoma patients treated by radiotherapy, especially in T4 and/or N3 patients. These patients need more intense treatment rather than radiotherapy alone.