不同射野治疗56例无口咽侵犯的T1～2N0鼻咽癌的前瞻性临床研究

目的评价不同射野放射治疗无口咽侵犯的T1～2N0鼻咽癌的临床疗效。方法将56例T1～2N01992年福州分期鼻咽癌病人随机分为面颈联合野组（A组）和面颈分野组（B组）。A组先设面颈联合野和下颈切线野，均照射56Gy后改双耳前野24Gy，鼻前野8～10Gy和颈前切线野14Gy：B组设置双耳前野60Gy，鼻前野8～10Gy，颈前切线野50Gy。结果放疗结束时，鼻咽原发灶消退率A组和B组分别为964％和929％，两组无显著差异。A，B两组病人5年总生存率均为75％。面颈分野组1例发生放射性颈脊髓损伤，但是研究组在治疗中较对照组减少了放射性咽喉炎及粘膜反应。对照组5例发生放射性颞颌关节损伤，其中1例为5级损伤。对照组26例发生放射性唾液腺受损口干发生率为92.9%，其中10例为2级损伤，远远高于治疗组的89.3％，5例为2级损伤，但由于病例少在统计学上无显著性差异，对此需进一步观察。结论无口咽侵犯的T1～2N0鼻咽癌病人选用面颈联合野或面颈分野，生存率无显著差异，远期放射损伤情况面颈分野体现一定的优势。

Objective To evaluate the radiotherapy effects of nasopharyngeal carcinoma （NPC） staged T1～2N0 without involvement of oropharynx were randomly divided into two groups （group A and B）. The patients in group A were treated with lateral faciocervical portels. The doses delivered to faciocervical portal, 8-10Gy to nose portal and 14tGy to the whole neck anterior tangential portal was 60Gy ,8- 10Gy to nose portal iand 50Gy to the whole neck anterior tangential portal. The patient in group B were treated with preauricular portal plus nose portals. The doses delivered to preauricular portal was 60Gy, 8-10Gy to nose portal and 14Gy to the whole neck anterior tangential portal. They were staged by the method of Fuzhou 1992 system. Results After treatment, the primary tumor disappearance a rates for group A and B were 96.4% and 92.9%,had no significant difference （P〈0.05） .The 5-year overall average survival rate were 75%.There was no difference of radiation reactions or late-damages between the two groups. But, the group who studies the group contrasts comparatively in curing middle has decreased by radioactivity faucitis and mucous membrane reaction, Contrast group 3 examples occurrence radioactivity Nie jaw joint injury, 1 examples among them harm for 3 steps, contrast group 26 examples occurrence radioactivity salivary glands that dry occurrence rate is damaged being 92.9%. But 10 examples among them are 2 steps of loss, over higher than the curing 89.3% of group, 5 examples harm for 2 steps, stop there being no notable difference on statistics, observe further to this necessaries because of pathological mechanism. Conclusion The post radiation survival rate in NPC of T1～2N0M0 without involvement of oropharynx has no difference between treatment by faciocervical portals and by preauricular portals.