全程加速超分割治疗局部晚期上颌窦癌的疗效分析

Clinical analysis on the effect of local advanced maxillary sinus carcinoma patients treated by whole course accelerated hyperfractionated radiotherapy

目的：评价全程加速超分割治疗局部晚期不能手术的上颌窦癌的疗效及预后。方法：1996年3月-2004年3月收住71例局部晚期不能手术的上颌窦癌患者,随机分为两组。（1）全程加速超分割组（CAHF）36例;每周5d,每天2次,每次1.5Gy,间隔时间6h以上,总量DT66-70Gy/44-46 f/32-34d;（2）常规分割照射组（CF）35例,5次/w,1次/d,每次2.0Gy,总量DT66-80Gy/33-35 f/44-46d。结果：常规照射组和全程超分割组1,2,3,4,5年的局控率分别为62.8%,34.3%,22.9%,14.3%,5.7%和88.6%,66.7%,52.8%,36.3%,25%（P〈0.05）;常规照射和全程加速超分割组1,2,3,4,5年的生存率分别为6 5.7%,4 5.7%,2 8.6%,2 2.8%,1 6%和9 4.4%,7 2.2%,5 8.3%,5 7.2%,3 6.1%（P〈0.0 5）,加速超分割组较常规分割组高,两组的晚期并发症及死亡原因无明显差异。结论：全程加速超分割放射治疗对不能手术的晚期上颌窦癌患者,能明显提高局控率和生存率,但口腔粘膜反应较常规分割组增高,但可耐受。

Objective： To evaluate the result of local advanced maxillary sinus carcinoma patients treated with whole course accelerated hyperfractionated radiotherapy（CAHF） . Methods： From March 1996 - March 2004,71 patients of local advanced maxillary sinus carcinoma were divided randomly into two groups： （ 1 ） CAHF group, 36 pa- tients were treated by whole course accelerated hyperfractionated radiotherapy. Radical tumoricidal dose of 75 - 80 Gy was delivered in 50 -54 fractions over 51 - 56 days （ 1.5 Gy/d, twice, a 6 hour interval）. （ 2 ） CF （ conventional frac- tionated radiotherapy） group, 35 patients were conventional fractionated radiotherapy （ DT60 - 70Gy/33 -35f/44 - 51d）. Results： 1,2,3,4 and 5 - year local control rates were 88.6% ,66.7%, 52.8% ,36.3% ,25% ;and 62.8%, 34.3% ,22.9%, 14.3% ,25.0% ;in CAHF and CF groups,respectively. 1,2,3,4 and 5 -year survival rates were 94.4% ,72.2% ,58.3% ,57.2% ,36.1% and 65.7% ,45.7% ,28.6% ,22.8% , 16% in CAHF and CF group respectively . The oral cavity acute side effect in CAHF group were more severe than those at CF group. But the patients could bear radioreaction in CAHF . Conclusion： Whole course accelerated hyperfractionated radiotherapy can be taken as a effective treatment for local advanced maxillary sinus carcinoma . It can improve local control rate and survival rate .