内窥镜下微波固化术治疗鼻咽癌放疗后鼻咽腔内复发患者的疗效

Endoscopic Microwave Coagulation Therapy for Locally Recurrent Nasopharyngeal Carcinoma

背景与目的:局部复发鼻咽癌的治疗是一个临床难题。再程放疗可治愈部分患者,但会带来明显后遗症。本研究旨在评价内窥镜下微波固化术治疗鼻咽癌放疗后鼻咽腔内复发患者的疗效。方法:选取1994年8月至2005年4月中山大学肿瘤防治中心采用内镜下微波固化术治疗的局部复发(rT1)鼻咽癌病例55例,分析其无局部进展生存率及总生存率。结果:本组病例中位随访时间为102.1个月(22.4～153.9个月)。放疗后局部复发的中位时间为22.1个月(6.5～125.6个月)。微波固化术后鼻咽局部再复发5例。5年无局部进展生存率和总生存率分别为90.7%和93.6%。55例患者均无术中并发症。1例患者术后出现鼻咽溃疡,1个月后愈合。结论:内窥镜下微波固化术治疗选择性的局部复发鼻咽癌(rT1)患者可取得较好的生存率及局控率且并发症少,是目前治疗局部复发鼻咽癌患者的一种操作简便易行、疗效较理想的救援性治疗方法。

BACKGROUND ＆ OBJECTIVE- Management of locally recurrent nasopharyngeal carcinoma （NPC） is difficult. External beam re-irradiation could cure some patients but might cause severe radiation injury. This study was to evaluate the clinical value of endoscopic microwave coagulation therapy as salvage treatment for locally recurrent NPC. METHODS： Between Aug. 1994 and Apr. 2005, 55 patients with locally recurrent NPC （stage rT1） were treated with endoscopic microwave coagulation therapy. Local progression-free and overall survival were observed. RESULTS, The median follow-up was 102.1 months （range, 22.4-153.9 months）. The median time from last irradiation to recurrence was 22.1 months （range, 6.5-125.6 months）. Five patients had local failure. The 5-year local progression-free and overall survival rates were 90.7% and 93.6% , respectively. No patient had intraoperative complications. One patient had nasopharyngeal necrosis after operation, and was healed after one month. CONCLUSIONS： Endoscopic microwave coagulation therapy is effective without severe complications in locally recurrent NPC patients. It is a minimally invasive therapy for recurrent NPC.