147例鼻咽癌调强放疗结果分析

Treatment results of intensity-modulated radiotherapy for nasopharyngeal carcinoma： an analysis of 147 patients

目的总结我院鼻咽癌调强放疗的经验和结果。方法5年内采用调强放疗初程鼻咽癌患者147例。T1-2期38例鼻咽原发病变靶区（GTVnx）和阳性淋巴结（GTVnd）的处方剂量为70．0～72．6Gy，高危区（CTV1）处方剂量为60Gy，低危区（CTV2）处方剂量为50Gy。T3-4期109例GTVnx74～78Gy，其他靶区处方剂量同T1-2期。局部控制率、生存率用Kaplan-Meier方法计算。结果中位随访时间15个月，全组3年局部控制率、总生存率、无瘤生存率和无远转生存率分别为93．2％、93．5％、72．6％和74．4％，T1-2、T3-4期局部控制率分别为100％和86．9％（P=0．007），总生存率为95．5％和91．3％（P=0．030）。N0-1和N2-3期的总生存率、无瘤生存率、无远转生存率分别为99％和68．5％（P=0．030）、79％和64．0％（P=0．004）、81％和65．2％（P=0．000）。急性腮腺功能损伤1＋2级为96．6％，3级为1．4％，2级发生于放疗后3、6个月和1、2年的分别为43．0％、12．0％和4．9％、3．2％。结论鼻咽癌调强放疗方案取得了很好的疗效同时保护了腮腺功能。

Objective To evaluate the efficacy of intensity-modulated radiotherapy（IMRT） as the primary treatment in nasopharyngeal carcinoma （ NPC ）. Methods Between November 2001 and March 2006,147 newly diagnosed NPC patients were treated with IMRT. The disease was Stage Ⅰ in 3 patients, Stage Ⅱin 35,Stage Ⅲ in 67 and Stage Ⅳ in 42. For T1-2 disease,the prescription dose was 70 Gy to the gross tumor volume（ GTV,, ） and positive neck nodes ,60 Gy to the planning target volume I, and 50-56 Gy to the clinically negative neck. For T3-4 disease, the prescription dose was 74-78 Gy to GTVnx. The local control rate（LC） ,overall survival （OS）, disease-free survival （DFS） and distant metastasis-free survival （DMFS） were estimated by Kaplan-Meier method. Results The 3-year LC,OS,DFS and DMFS of the whole group were 93.2% ,93.5% ,72.6% and 74.4% ,respectively. T stage was a significant predictor of LC and OS. For patients with T1-2 and T3-4disease,the LC was 100% and 86.9% （P = 0. 007） and OS was 95.5% and 91.3% （ P = 0.030） , respectively. N stage was a significant predictor of OS, DFS and DMFS （ P = 0.03, 0. 004 and 0.0004, respectively）. The grade Ⅰ＋ Ⅱ and m acute toxicities of parotid were 96.6% and 1.4%. The rate of grade Ⅱ xerostomia at 3-month, 6-month, 1-year and 2-year after radiotherapy were 43.0%, 12.0% ,4.9% and 3.2%. Conclusions The treatment results are promising according to our target definition and dose prescription protocol for nasopharyngeal carcinoma.