后程加速超分割放射治疗鼻咽癌的临床研究

Late-course Accelerated Hyperfractionation Radiotherapy for Nasopharyngeal Carcinoma

[目的]观察后程加速超分割治疗鼻咽癌的疗效及毒副反应。[方法]对45例初治鼻咽癌患者分为常规分割组(常规组)和后程加速超分割组(后超组)。常规分割组:22例,每天2Gy/次,5次/周,鼻咽原发灶中位肿瘤剂量70Gy～72Gy/DT;后程加速超分割组:23例,先常规分割照射,每天2Gy/次,5次/周,放射剂量至38Gy～40Gy/DT后改用加速超分割放疗方案,1.5Gy/次,2次/d(相隔≥6h),5d/周,总剂量72Gy～76Gy。[结果]放疗结束后3个月,常规组、后超组内窥镜检查鼻咽原发灶完全消退率分别为90.91%、100%。常规组、后超组1、3年鼻咽原发灶控制率分别为95.45%、67.53%和100%、90.91%,有显著性差异(χ2=4.03,P﹤0.05);1、3年生存率分别为95.45%、63.64%和95.65%、73.91%,无显著性差异(χ2=0.59,P>0.05)。常规组、后超组放射治疗的早期放射急性口腔黏膜反应Ⅲ级发生率,分别为18.18%(4/22),52.17%(12/23)(χ2=4.28,P﹤0.05),差异有显著性;两组病例的远期放射反应未见有显著性差异。[结论]后程加速超分割治疗鼻咽癌的近期肿瘤局部控制率明显高于常规分割组,但生存率无差别;早期放射急性口腔黏膜反应较常规组严重,但大多患者能够耐受。

[ Purpose] To evaluate the clinical results of late-course accelerated hyperfractionation （LCAF） radiotherapy for nasopharyngeal earcinoma（NPC） patients. [Methods] Forty-five NPC patients were divided into conventional fraetionation（CF） and LCAF radiotherapy groups. Twenty-two patients in CF group received conventional radiotherapy： 2.0Gy/F for 5 fractions a week to a total dose of 70Gy-72Gy/DT. Twenty-three patients in LCAF group were treated with the same conventional fractionation as CF group until the （lose of 38Gy-40Gy, then followed by LCAF radiotherapy：1.5Gy/F, twice per day with 6 hours interval between the two fractions,to a total dose of 72Gy-76Gy/DT. [Results]With assessment for primary tumor 3 months after radiotherapy, complete response rate was 100% in LCAF group and 90.91% in CF group 3 months after radiotherapy. The 1-,3-year local control rate was 100%,90.91% in the LCAF group and 95.45%, 67.53% in CF group respectively with significant difference （X^2=4.03,P〈0.05）. The 1-,3-year survival rate was 95.65%, 73.91% in LCAF group and 95.45%, 63.64% in CF group respectively （X^2=0.59,P〉0.05）,The oropharyngeal mueosa grade HI acute radiation toxicity was 12/23（52.17%） in LCAF group and 4/22（18.18%） in CF group （X^2=4.28,P〉0.05）. The late radiation toxicity was not significantly different between the two groups. [Conelusion] The local control rate of NPC treated by LCAF radiotherapy is superior to that by CF radiotherapy. There is no significant difference in the survival rates between the two groups.The acute radiation toxicity in LCAF group was more severe than that in CF group, however it is tolerable in maiofitv of patients.