79例复发性鼻咽癌三种不同方法再程放疗的疗效探讨

Analysis on the Curative Effect of Re-Irradiation by Three Different Methods in Treating 79 Cases of Recurrent Nasopharyngeal Carcinoma

目的探讨三种不同治疗方法对鼻咽部复发性鼻咽癌患者预后的影响。方法收集1998年1月-2001年1月,经病理确诊住院治疗的79例复发性鼻咽癌患者的资料。按其再程放射治疗的方法不同进行分组,超分割放射治疗(HF/RT)32例,常规放射治疗(HT)29例,化疗+常规放射治疗(PF/RT)18例(5-氟尿嘧啶+顺铂诱导化疗2个周期+常规放疗)。三组均采用6MV直线加速器外照射,总剂量HF/RT组(70+5)GY,RT及PF/RT组(68+5)GY。结果临床CR率分别为78.53%(25/32)、62.07%(18/29)和72.22%(13/18),病灶未控及远处转移率以RT组为高,分别为31.03%和37.93%,而HF/RT组和PF/RT组仅15.62%、25%和22.22%、16.66%,全组3年生存率31.65%,其中HF/RT组为37.50%(12/32)明显高于RT组的27.58%(8/19)和PF/RT组的33.33%(6/18),但三组3年生存率比较无统计学差异(Logrankteat:x2=3.4173,P=0.1811)。3年放射性脑脊髓病的发生率分别是9.37%、10.30%和11.11%无明显差异。结论超分割放疗或诱导化疗+放疗,对提高鼻咽部复发性鼻咽癌的远期疗效无实质性意义。

Objective To explore the effect of re-irradiation by three different methods on the prognosis of recurrent nasopharyngeal carcinoma. Methods The clinical data of 79 cases of pathologically confirmed patients with recurrent nasopharyngeal carcinoma were collected from January 1998 to January 2001 .The patients were divided into three groups according to the different methods of re-irradiation.32 cases were treated with hyperfractionation radiotherapy (HFRT), 29 cases were treated with routine radiotherapy(RT)and 18 cases were treated with themotherapy and routine radiotherapy (5-Fu+DDP+RT, PFRT). All patients were irradiated with 6 MV linear accelerator, with a total dose of (75±5)GY in HFRT, (70±5)GY in RT and PFRT. Results The complete response (CR) rates of HFRT, RT and PFRT were 78.53% (25/32), 62.07%(18/29) and 72.22 %(13/18), respectively. The rate of uncontrolled site and remote metastasis in RT were 31.03% and 37.93%, in HFRT were 15.62% and 25%, and in PFRT were 22.22% and 16.66%,respectively. The overall 3-year survival rate of all patients was 31.65%. The 3-year survival rate in HFRT (37.50%, 12/32) was higher than that in RT (27.58, 8/29) and in PFRT (33.33%, 6/18). But there were not statistical discrepancies among 3-year survival rates (Logrank test:x2=2.3378,P=0.3107). The occurrence rates of 3-year radiation encephalomyelopathy of the 3 different treatments were 9.37% , 10.30% and 11.11% , without no significant difference. Conclusions The re-irradiation with HFRT, RT and PFRT have similar efficacy in treatment of recurrent nasopharyngeal carcinoma. Three methods all can be chosen to treat recurrent nasopharyngeal carcinoma.