鼻咽癌原发肿瘤容积与放射治疗疗效关系的研究

Relationship between primary tumor volume and radiotherapeutic outcome in nasopharyngeal carcinoma

目的 分析鼻咽癌原发肿瘤容积与放射治疗疗效的关系。方法 无远地转移的 1 5 4例初治鼻咽癌患者行超分割后程加速放射治疗 ,原发灶总剂量为 78Gy ,6 0分次 ,6周完成。在治疗前CT资料上勾画鼻咽部肿瘤 ,采用求和方法算得肿瘤容积。结果 不同T分期中肿瘤容积变化范围很大 ,T1、T2、T3、T4期平均肿瘤容积 (范围 )分别为 1 8.9(0 .5 5～ 5 9.33)、2 5 .8(2 .2 2～ 80 .6 4 )、39.3(1 3.97～87.97)、5 9.7(2 6 .1 8～ 1 1 5 .0 0 )cm3 。单因素分析显示原发肿瘤容积 >6 0cm3 的患者 5年鼻咽部控制率、无瘤生存率和无远地转移率均明显降低。多因素分析中 ,原发肿瘤容积是影响局部控制的一个独立预后因子 ,但该因素在影响无瘤生存率和无远地转移生存率的因素中未达统计学意义。结论 鼻咽癌不同T分期中存在着很大的肿瘤容积重叠范围 ,原发肿瘤容积是影响放射治疗疗效的一个重要因素。

Objective To investigate the correlation of primary tumor volume of nasopharyngeal carcinoma with the clinical result of radiotherapy. Methods One hundred and fifty-four patients diagnosed as nasopharyngeal carcinoma were treated with late-course accelerated hyperfractionated radiotherapy alone to a total dose of 78?Gy/60 Fx/6 w. The primary tumor volume was first obtained by contouring the tumor lesion on the CT images , then its volume was accumulated with the area summation model. The median follow -up was 49.5 months. Results Evident volume disparity with different T stages and the volume data overlap between continuous T stages were found. The mean primary tumor volumes and their ranges were as (cm 3):T1 18.9(0.55～59.33),T2 25.8(2.22～80.64),T3 39.3(13.97～87.97) and T4 59.7(26.18～115.00). Univariant analysis showed that the poorer 5-year local control , disease-free survival and distant relapse-free survival rates were evident in patients with larger tumor volume (>60 cm 3). Primary tumor volume was found to be an independent prognostic factor of local control in multivariant analysis without any statistical significance to predict the disease-free survival or distant relapse-free survival rates. Conclusion The greater volume disparity with the same T stage and the data extension overlap with different T stages are demonstrated and the primary tumor volume may be considered as a prognostic factor in the treatment of nasopharyngeal carcinoma.