鼻咽癌复发方式及不作预防性颈部照射的结果

PATTERNS OF RELAPSE AND RESULTS OF WITHHOLDING ELECTIVE NECK IRRADIATION (ENI) FOR NASOPHARYNGEAL CARCINOMA

鼻咽癌除易于广泛局部浸润外,亦有较高的血源性播散及早期淋巴结转移发生率。 以前何氏研究显示淋巴结阴性者不予预防照射多数病例无转移,既使后发生淋巴结受累,治疗后不影响最终生存率。因此,除预计患者不能按期观察或有特殊较差预后外,我院对淋巴结阴性的鼻咽癌不做预防性照射。本文回顾1981年至1985年治疗病例,以探讨治疗失败的原因。

It is a retrospective analysis of 2523 available patients suffering from nasopharyngeal squamous cell carcinoma who were treated during 1981-1985. 91% (2294/2523) of patients recie\ ed total course of high-energy irradiation. Medium equivalent dose in nasopharyngeal region was 65 Gy and 53 Gy to the cervical region involved^ 75% (499/666) patients without lymph node involved did not recieve regional irradiation. The actuarial 5-year survival rate was 57%. Recurrence free rate was 42%. The actuarial 5-year local and regional relapse free rates and distant metastasis free rates were 70%. 69% and 65%, respectively. The distant metastasis rate was related to N and T (N0 15%, N1 25%, N2 35%, N3 54%; T1 27%, T2 31%, T3 36%). 28% of the patients had regional failure (11% were residual and 17% were recurrence). After cervical irradiation the regional relapse rate in positive and negative node patients were 12% (215/1755) and n% (19/167) respectively, whereas 38% in those negative node patients who did not recieve elective node irradiation (ENI). For those patients without ENI, therapeutic irradiation resulted in 92% node remission. Although regional salvage treatment was quite successful,the distant dissemination rate was higher in these patients than in patients without regional relapse (20% vs 5%). Because elective node irradiation can effectively reduce local recurrence and does not result in severe complications, it should be applied to all patients with negative cervical node.