69例复发鼻咽癌近距离超分割放疗远期疗效分析

Long-term efficacy of hyperfractionated intracavitary brachytherapy on 69 patients with locally recurrent nasopharyngeal carcinoma

背景与目的:局部复发是鼻咽癌治疗失败的原因之一。复发鼻咽癌再治疗有放疗、手术、化疗及靶向治疗等,其中放疗是最主要的方法。再放疗有多种方式,包括常规外照射、近距离治疗、三维适形及调强放疗等。本研究通过回顾性分析局部复发再分期为早期的鼻咽癌采用单纯腔内近距离超分割放疗或联合常规外照射的远期疗效及晚期放射性损伤,评估近距离超分割放疗在复发鼻咽癌中的应用价值。方法:鼻咽癌首程放疗后局部复发再分期为T1和T2的69例患者,其中rT1 51例,rT2 18例。20例接受单纯腔内近距离超分割放疗,每次2.5～3.0 Gy,每天2次,间隔超过6 h,连续治疗5 d,休息1周后再连续治疗5 d。照射剂量为40～50 Gy,中位剂量50 Gy。49例在常规外照射剂量达30～65 Gy,中位剂量50 Gy,休息1～4 d后加用腔内近距离推量8～48 Gy,中位剂量20 Gy,近距离照射方式同前。结果:全组再程放疗后3年和5年生存率分别为59.66%和39.66%;3年和5年局部控制率分别为86.3%和77.2%;晚期并发症中鼻咽溃疡发生率26.1%;张口受限39.1%;后组颅神经损伤30.4%;放射性脑病13.0%。再放疗后单纯近距离治疗组及联合治疗组张口受限分别为4例和23例(P=0.038),鼻咽溃疡分别为6例和12例(P=0.636)。结论:鼻咽癌复发再分期为早期者采用腔内近距离超分割放疗临床实施可行,值得推荐。

Background and purpose:Local recurrence is one of treatment failure cause for nasopharyngeal carcinoma(NPC).Further treatments for locally recurrent NPC are available,such as surgery,chemotherapy,targeted therapy and radiotherapy is the most important of all.There are several radiotherapy methods,including conventional external beam,brachytherapy,three-dimensional conformal and intensity modulated radiotherapy.This study retrospectively analyzed the long-term outcomes and late radiation injuries of locally recurrent NPC that were treated with hyperfractionated intracavitary brachytherapy or combined with external beam radiotherapy for the purpose of assessing the value of hyperfractionated intracavitary brachytherapy.Methods:Sixty-nine patients were enrolled to restaged T1(51 cases) and T2(18 cases) of locally recurrent NPC.Twenty patients received hyperfractionated intracavitary brachytherapy with a median dosage of 50 Gy(ranged 40-50 Gy).The remaining 49 patients received external beam radiotherapy with a median dosage of 50 Gy(ranged 30-65 Gy) plus hyperfractionated intracavitary brachytherapy with the median dose of 20 Gy(ranged 8-48 Gy) boosted.Two courses of brachytherapy were delivered,each consisting of 2.5-3.0 Gy per fraction,each of the 2 fractions were spaced 6 hours apart and lasting for 5 days.The second course of brachytherapy was delivered after one week of rest.Results:The 3 and 5-year overall survival rates were 59.66% and 39.66%.The 3 and 5-year local tumor control rates were 86.3% and 77.2%,respectively.After the reirradiation,the incidence rates for nasopharyngeal ulceration,trismus,lower cranial nerve palsy and radiation encephalopathy were 26.1%,39.1%,30.4% and 13.0%,respectively.Cases of trismus and nasopharyngeal ulceration in the brachytherapy group versus in the combined group were 4 versus 23(P=0.038) and 6 versus 12(P=0.636),respectively.Conclusion:Hyperfractionated intracavitary brachytherapy is feasible for locally recurrent nasopharyngeal carcinoma that is restaged early.The 5-year overall survival and local tumor control rates were 39.66% and 77.2%.Hyperfractionated intracavitary brachytherapy can be recommended for rT1 and rT2 locally recurrent nasopharyngeal carcinoma.