鼻咽癌肺转移不同治疗方法的探讨

The results and prognosis of different treatment for lung metastasis from nasoph aryngeal carcinoma :analysis of 60 patients

目的 分析鼻咽低分化癌肺转移患者的治疗结果,寻求较为合理的治疗方案。方法 对6 0例鼻咽癌肺转移的患者进行肺转移发生情况、治疗方式、近期疗效和远期疗效及不同治疗方式对预后影响的分析。肺转移治疗方式包括单纯化疗;局部小野照射;全肺照射+局部小野补量;全肺照射+局部小野放疗+化疗。化疗方案主要为顺铂+氟尿嘧啶+平阳霉素,全肺照射单次剂量10 0～15 0cGy ,总剂量18～2 1Gy ;肺转移灶补量至5 0～6 0Gy ,均为未校正剂量。结果 鼻咽癌肺转移多为肺内多发转移,占肺转移的81.7%。4 5 %患者在整个病程中合并其他脏器转移。肺转移后3、5年总生存率分别为35 .0 %、30 .2 %。放疗对肺转移病灶的近期疗效明显好于化疗(P =0 .0 33)。全肺照射+局部小野补量放疗后给予辅助化疗的综合治疗明显好于其他治疗方式(P =0 .0 0 2 )。结论 放疗是鼻咽癌肺转移病灶的有效治疗手段。对鼻咽局部无复发、肺内单发转移灶、不合并有其他脏器转移者,可先试行局部小野照射。对鼻咽局部无复发、肺内多发转移灶、不合并有其他脏器转移者,可行全肺照射+局部小野补量,然后给予全身化疗。对合并有其他脏器转移的,建议全身化疗。

Objective To find a more reasonable and effective treatment mod ality for lung metastasis in nasopharyngeal carcinoma by analyzing the results a nd prognosis factors. Methods From January 1988 to July 2003, 60 patients with lung metastasis from nasopharyngeal carcinoma were treated in our hospital, wit h incidence, time, modality as well as immediate and remote results analyzed. Su rvival was calculated by Kaplan-Meier method. The difference of survival betwee n different modalities was evaluated by logrank test. The difference in response rates among different modalities was evaluated by χ2 test. Re sults Most of t he patients had multiple lesions in the bilateral lung(81.7%). About 45%(27 /60 )of the patients would develop multi-organ metastases during their life, and 9 6 .3% of these multi-organ lesions would appear within 9 months after lung metast a sis. The overall 3- and 5-year survival rates were 35.0% and 30.2% respectivel y. The response rate of radiotherapy for the lung metastasis was much better than chemotherapy(P=0.033). The most promising overall survival was o btained with who le lung irradiation plus local boost irradiation and followed by supplementary a djuvant chemotherapy(P=0.002). Conclusions Radiotherapy is one o f the most ef fective treatment for lung metastasis from nasopharyngeal carcinoma in the follo wing conditions: 1. Lung metastasis without loco-regional recurrence, 2. Only one lesion in the lung, therefore, we may irradiate the lesion with a local sma ll f i eld, 3. For patients having multi-lesions in the lung but nolocoregional recurr en ce, the best choice is whole lung plus local boost followed by adjuvant chemothe rapy, and 4. For patients with multi-organ metastases, chemotherapy seems manda tory.