鼻咽癌根治性放疗10年经验总结

Ten-year experience of radical radiotherapy for nasopharyngeal carcinoma:analysis of 905 patients

目的分析20世纪最后10年内收治的鼻咽癌患者的根治性放疗结果,探求更好的治疗方案。方法10年内首程根治性放疗患者共905例。分析放疗患者的预后、失败模式及其影响因素等。生存率用Kaplan-Meier法计算,组间差别用Logrank检验,失败模式的影响因素组间差别用X^2检验。结果全组5和10年总生存率、局部控制率、无瘤生存率分别为76．1%和66．5%、81．7%和76．7%、58．4%和52．1%。单因素分析显示年龄、卡氏评分、贫血、T和N分期及临床分期是影响总生存率和无瘤生存率的因素。多因素分析显示年龄、贫血是总生存率的独立预后因素,年龄、T和N分期及临床分期是无瘤生存率的独立预后因素。共有254例治疗后出现失败,失败率为28．0%。首次失败为局部未控104例(40．9%)、远处转移124例(49．0%)。骨转移是最常见部位,其次是肝和肺。结论目前鼻咽癌根治性放疗已取得较好成绩。治疗前改善患者一般状况、纠正贫血、早期发现患者、降低T4和(或)N3期患者的远处转移是进一步提高疗效的研究方向。

Objective To report our experience of radical radiotherapy for nasopharyngeal carcinoma （NPC） in our institution during the last decade. Methods From January 1990 to May 1999, 905 NPC patients were treated and studied retrospectively. The impact of boost irradiation to the residual tumor after 70-72 Gy external beam radiotherapy（EBRT） on the treatment results, the pattern of failure and related prognostic factors were summarized. Results The 5- and 10-year local-regional control, overall survival and disease-free survival rates were 81.7% and 76.7%, 76.1% and 66.5%, 58.4% and 52.1%, respectively. For residual primary lesion after a dose of 70-72 Gy of conventional EBRT, an additional boost was able to achieve a local control of 80.8%, similar to that obtained with primary lesion which had completely disappeared at 70-72 Gy（82.6%, P = 0.892）. Age, Kamovsky performance status, pretreatment hemoglobin level, T and N stage were shown to he prognostic factors for overall survival and disease-free survival. On tmivariate analysis, age, T and N stage and clinical stage were independent factors for local control and disease-free survival, whereas T and N stage were independent factors for overall survival. T4 and N3 stage were predictive for distant metastasis （ P 〈 0.05）, of which bone was the most common site, followed by fiver and lung. Conclusions The treatment results of radical external beam radiotherapy followed by a boost irradiation to the residual primary tumor for nasopharyngeal carcinoma in our institution are promising. Local-regional relapse and distant metastasis were the major cause of failure, especially for the T4 and N3 stage patients. Early diagnosis and improvement of the outcome for locally advanced lesion are the main goal of our further clinical research.