适形放疗联合近距离治疗鼻咽癌复发与局部残存病灶

CONFORMAL RADIOTHERAPY COMBINED WITH BRACHYTHERAPY FOR RECURRENT AND RESIDUAL NASOPHARYNGEAL CARCINOMA

目的评价三维适形放疗联合腔内近距离治疗鼻咽癌复发与局部残存病灶的临床价值.方法 36例鼻咽癌复发与局部残存病灶患者,对其中的17例复发组患者设5～7个适形野, 5次/周, 2 Gy/次,放疗至20～28 Gy后,改超分割照射1.5 Gy/次, 每日2次,间隔6 h, 10次/周,放疗至总量50～58 Gy, 休息1～2周后腔内近距离治疗1～2次, 1次/周, 5 Gy/次.对19例残存组患者适形放疗5次/周, 2 Gy/次,总量至68～72 Gy后,休息1～2周后追加腔内近距离治疗1～2次, 1次/周, 5 Gy/次.结果适形放疗90%以上等剂量曲线适形靶区,急性放射性黏膜损伤一般,所有患者经适当对症处理后均顺利完成治疗计划,未出现严重的放疗并发症,近期疗效复发组和残存组(CR+PR)分别为88.23%和89.47%.结论三维适形放疗联合腔内近距离治疗,作为治疗鼻咽癌复发与局部残存病灶的一种方法是有效和可行的,建议近距离治疗时采用放置后装模的CT图像进行参考点选择.

Objective To evaluate the value of conformal radiotherapy combined with brachytherapy for recurrent and residual nasopharyngeal carcinoma. Methods Out of 36 cases of recurrent and residual nasopharyngeal carcinoma, 17 cases were treated by conformal radiotherapy with the dose of 20-28 Gy/10-14f/2-3 weeks, followed by hyperfraction conformal radiotherapy with the total dose of 50-58 Gy, 2 f/day and 1.5 Gy/f, distanced 6 hours, after a rest of 1 - 2 weeks added brachytherapy of 1-2 f, 1 f/week, 5 Gy/f. 19 cases of residual nasopharyngeal carcinoma were treated by conformal radiotherapy with the dose of 68- 72 Gy/34- 36f/6- 7 weeks. After 1-2 weeks added brachytherapy of 1-2 f, 1 f/week, 5 Gy/f. Results The reference 90% isodose curves conform to the target in the dimensions by conformal radiotherapy. The damnification of the acute radioactivity mucous membrane was common and the side of effect of radiotherapy was slight. The CR and PR of the group of recurrent and residual was 88.23 % and 89.47 %. Conclusions As a method of treated recurrent and residual nasopharyngeal carcinoma, conformal radiotherapy combined with brachytherapy was effective and feasible.