分次立体定向放射治疗在局部残存、复发鼻咽癌中的应用

Fractionated stereotactic radiotherapy for locally residual or recurrent nasopharyngeal carcinoma

目的:评价对鼻咽癌患者放射治疗后局部残存、区域复发进行分次立体定向放射治疗(FSRT)的临床价值和毒副作用。方法:对24例鼻咽癌放疗后局部残存、区域复发的患者,应用奥沃光子公司生产的立体定向放射治疗系统,10MV X射线,80%为参考剂量曲线,肿瘤边缘分次剂量为4-6Gy/次,2-3次/周,总剂量为8Gy-24Gy。患者分为2组:A组18例为首程根治性放射治疗后6个月内经鼻咽镜、CT或MRI检查仍有较大肿块残存;B组6例为首程根治性放射治疗后6个月以上区域复发者。结果:24例患者CR为66.7%(16/24),PR 29.1%(7/24),NC 4.2%(1/24),CR+PR 95.8%(23/24)。鼻咽部大出血的发生率为16.7%(4/24)。结论:对鼻咽癌放射治疗后局部残存、区域复发,采用分次立体定向放射治疗推量治疗是一种有效的方法,鼻咽部大出血是其严重的并发症。

Objective：To evaluate the clinical value and the side effect of fractionated stereotactic radiotherapy （FSRT） for residual or recurrent nasopharyngeal carcinoma. Methods： During the period of August 2001 and November 2003 ,24 patients were treated by FSRT with 10 MV photons. 80% isodose curves covered lesion where the total FSRT dose were 8 -24Gy of fraction size 4 -6Gy, with interfraction duration of 1 -2 days. The patients were divided into two groups. Group A： 18 patients with residual occurring less than 6 months after first standard radio- therapy. Group B ： 6 patients with recurrent occurring over 6 months after first standard radiotherapy. Results ： In all 24 patients： CR was 66.7% , PR 29.1% and NC 4.2%, CR ＋ PR 95.8%. The incidence of nasopharyngeal massive hemorrhage was 16.7%. Conclusion： Fractionated stereotactic radiotherapy（FSRT） is an effective treatment modality for residual or recurrent nasopharyngeal carcinoma at the primary focus. Nasopharyngeal massive hemorrhage is the serious complication.