鼻咽癌初程放疗后残存的分次X刀治疗初探

Fractionated radiosurgery for residual lesion after the first course of radiothe rapy for nasopharyngeal carcinoma

目的 回顾性分析分次立体定向放射外科治疗鼻咽癌放疗后残存肿瘤疗效 ,评价其临床应用价值。方法 98例鼻咽癌放疗后鼻咽局部残存患者采用分次立体定向放射外科技术推量治疗。 1992年福州分期Ⅰ期 2例 ,Ⅱ期 2 9例 ,Ⅲ期 5 3例 ,Ⅳa期 14例。UICC 1997分期Ⅰ期 2例 ,Ⅱa期2例 ,Ⅱb期 2 7例 ,Ⅲ期 37例 ,Ⅳa期 2 1例 ,Ⅳb期 9例。分次立体定向放射外科治疗总剂量为 12～2 4Gy ,分次剂量为 4、5、6、7、8、12Gy,间隔 1～ 7d ,1～ 4个中心 ,6 0 %～ 90 %参考剂量线。结果 完全控制 95例 ,无法评价 3例 ,局部控制率为 97%。 1、2、3、4、5、年总生存率分别为 94 %、86 %、82 %、80 %、74 %。 1、2、3、4、5、年无瘤生存率分别为 88%、82 %、80 %、78%、75 %。随诊超过 6年的 2 4例中 ,无瘤生存 14例 ;3例随诊满 8年生存 3/ 3,8例满 7年生存 4 / 8,13例满 6年生存 7/ 13。结论 分次立体定向放射外科治疗鼻咽癌放疗后鼻咽残存肿瘤有肯定临床价值 ;选择合适病例能获满意疗效 ;剂量分割方式有个体化特点 ;晚期组织损伤应引起高度重视 ;重视肿瘤控制与周边正常组织结构损伤与修复的平衡关系。

Objective Ninety-eight nasopharyngeal carcinoma patients who developed local residual lesion after the first course of radiotherapy and treated with f ractionated radiosurgery were retrospectively analyzed with empharis on its clin ical value. Methods From September 1995 to March 2004, 98 such patients were tr eated by fractionated stereotactic radiosurgery. Their stages before radiotherap y,according to the Fuzhou Staging System (1992) were: I 2, Ⅱ 29, Ⅲ 53 and Ⅳa 14,and UICC Staging System (1997) were: I 2, Ⅱa 2, Ⅱ b 27,Ⅲ 37,Ⅳ a 21, Ⅳ b 9. Total dose was 12-24 ?Gy in fractions of 4,5,6,7,8 and 12 ?Gy spaced at inter val of 1-7 days on 1-4 centers. The reference dose line was 60%-90%. Results Wit h 3 patients unevaluable,the complete control was observed in 95(100%) patients. Local control rate was 97%.The 1-,2-,3-,4-,5-year overall survival rates w ere 9 4%,86%,82%,80%,74%,and the tumor-free 1-,2-,3-,4-,5-year survival rates we re 88% ,82%,80%,78%,75%. Among the 24 patients who have been followed for more than six years,14(58%) are alive. Among 13 patients who have been followed for 6 year,7 are alive.In the same way, 4 of 8 patients are alive after 7 years;3 of 3 patien ts are alive after 8 years. Conclusion Definite benefit is observed in fractiona ted stereotactic radiosurgery for local residual lesion after the first course o f radiotherapy for nasopharyngeal carcinoma. Adequate choice of patient, individ ualized fractionations, meticulous care in avoiding late tissue damage and due e mphasis on the balance of tumor control aganst repair of the nearby normal tissu es are of paramount importance to ensure a satisfactory result.