超分割后程加速放疗鼻咽癌长期结果分析

Late course accelerated hyperfractionation radiotherapy for nasopharyngeal carcinoma

目的研究鼻咽癌后程加速超分割放疗对鼻咽局部控制、生存的影响和并发症状况。方法全组178例鼻咽癌患者于1995年12月至1998年4月行首次单纯放疗,鼻咽原发灶采用^(60)Coγ线或6 MV X线外照射,其中前4周采用超分割1．2Gy/次,2次/d,5d/周,间隔≥6h,剂量为48Gy分40次；后2周采用加速超分割1．5Gy/次,2次/d,间隔≥6h,5d/周,剂量为30Gy分20次,全疗程的总剂量为78Gy分60次6周完成。结果急性黏膜反应中鼻咽黏膜反应0级仪2例,1级43例,2级78例,3级52例,4级3例。鼻咽5年局部控制率为87．7%,颈部5年局部控制率为85．7%。5年生存率为67．9%。5年远处转移率为26．1%,颅神经损伤占9．0%。结论该方法患者能耐受,5年局部控制率、生存率比常规分割和超分割有所提高,颅神经等晚期放射性损伤未见明显增加。

Objective To study the efficacy of late course accelerated fractionation（LCAF） radiotherapy in the treatment of nasopharyngeal carcinoma（NPC）. The end-po s were local control, radiation-induced complications, factors influencing survival. Methods From December 1995 to April 1998, 178 NPC patients were admitted for radiation treatment. The radiation beam used was ^06Co γ or 6 MV X-ray. For the first two-thirds of the treatment, two daily fractions of 1.2 Gy were given to the primary lesion , with an interval of ≥6 hours, 5 days per week to a total dose of 48 Gy/40 fractions, over a period of 4 weeks. For the last one third of the treatment, i.e. beginning from the 5th week, an accelerated hyperfractionation schedule was carried out. The dose per fraction was increased to 1.5 Gy, 2 fractions per day with an interval of≥6 hours, the total dose for this part of the protocol was 30 Gy/20 fractions over 2 weeks. Thus the total dose was 78 Gy in 60 fractions in 6 weeks. Results All patients completed the treatment. Acute mucositis： none in 2 patients, Grade 1 in 43 , Grade 2 in 78, Grade 3 in 52, and Grade 4 in 3 patients. Local control rate： the 5-year nasopharyngeal local control rate was 87.7% , and the cervical lymph node local control rate was 85.7%. The 5-year distant metastasis rate was 26.1% , and 5-year survivals was 67.9%. Sixteen patients had radiation-induced cranial nerve palsy. Conclusions With this treatment schedule, patient＇s tolerance is good, local control and 5 year survivals are better than control groups of conventional fractionation and hyperfractionation radiotherapy. Radiation-related late complication does not increase. Randomized clinical trials are being carried out to further confirm the efficacy of LCAF for nasopharyngeal carcinoma.