初治鼻咽癌调强适形放疗近期临床观察

The Short-term Clinical Observation of IMRT in First-treated Nasopharyngeal Carcinoma

目的 研究调强放射治疗（IMRT）对初治鼻咽癌的疗效以及对正常组织的保护和毒性反应。方法 对24例鼻咽癌初治患者鼻咽和全颈及锁骨上全程实施IMRT，肿瘤靶区授予处方剂量68～70Gy。对于Ⅲ和Ⅳ期患者，在IMRT同时，结合患者淋巴结转移及一般情况给予PDD＋5-Fu±THP-ADM方案化疗1～2周期。结果 治疗计划结果显示，覆盖鼻咽GTV1D95的平均剂量为70．48Gy，GTvlV95的平均体积为98．46％；靶区内GTV1、GTV2、CTV1和CTV2的平均剂量分别为70．48Gy、66．98Gy、60．10Gy和51．18Gy。本组有2例、16例、5例和1例患者分别出现0、1、2和3级的皮肤急性放射性反应；有4例、6例、13例和1例患者分别出现1、2、3和4级的口腔粘膜急性放射性反应；其中1例合并联合化疗患者因严重口腔粘膜炎中断放疗1周。其他合并化疗患者在化疗后均出现不同程度的骨髓抑制，经对症处理均未影响正常放射治疗。本组患者中位随访期13个月。无1例出现局部复发或远处转移。结论 IMRT在初治早期或晚期鼻咽癌病例均可获得理想的剂量分布，正常组织得到很好的保护，毒副反应可以耐受，临床疗效令人满意。

Objective To evaluate the feasibility, toxicity and clinical efficacy of intensity modulated radiation therapy （IMRT） for first-treated nasopharyngeal carcinoma. Metlmds Twenty-four patients of first-treated nasopharyngeal carcinoma were treated with full course IMRT including nasopharynx and full neck to supraclavicle. The radiotherapy dosage is 68-70Gy to the target. Of these patients, those who were classified as clinical stage Ⅲ or Ⅳ received 1 or 2 courses concurrent chemotherapy, and the chemotherapy regiment is PDD＋ 5-Fu ± THP-ADM. llesdts The results of treatment plan showed that the mean dose of coveting gross tumor volume（GTV）（D95） in the nasopharynx was 70. 48Gy and the mean volume of GTV1 （V95） receiving the 95% dose was 98. 46%. The mean dose of GTV1 ,GTV2,clinical targe volume CTV1 and CTV2 in the targes were 70. 48Gy,66. 98Gy,60. 10Gy and 51.18Gy. According to the evaluation, the acute skin toxicity in those patients were 2 patients with grade 0, 16 with grade 1, 5 with grade 2 and 1 with grade 3. Accordingly, the acute mucositis were 4 with grade 1, 6 patient with grade 2, 13 with grade 3 and 1 patients with grade 4. Only one patient had to stop the treatment for one week because of serve mucositis. Those patients received concurrent chemotherapy developed different blood toxicity, but didn＇t affect their treatment after well done. The median follow-up time is 13 months. Conclusion IMRT yields well dose distribution and acceptable toxity in both firsttreated early and advanced stage ruasopharyngeal carcinoma. The preliminary clinical result is encouraging.