早中期鼻咽癌外照射联合腔内放疗长期疗效的前瞻性研究

Prospective Study of Long Term Outcome in Nasopharyngeal Carcinoma Early and Middle Stage Treated with Combined External and Intracavitary Radiotherapy

[目的]探讨Ⅰ、Ⅱ期鼻咽癌患者采用单纯外照射放疗与外照射加腔内联合放疗的长期疗效。[方法]前瞻性研究453例Ⅰ、Ⅱ期鼻咽癌患者,随机分为单纯外照射组297例,联合照射组156例;单纯外照射组采用低熔点铅挡块不规则野照射,常规照射,常规分割,总剂量为66～74Gy;联合照射组采用同样的外照射方法,总剂量给予58～62Gy,并给予15～20Gy腔内近距离放疗。[结果]单纯外照射组和联合照射组的5年鼻咽局控率分别为Ⅰ期92.86%、96.43%(P=0.35),Ⅱ期89.02%、94.53%(P=0.01);5年总生存率分别为Ⅰ期88.10%、92.86%(P=0.27),Ⅱ期81.18%、90.63%(P=0.03)。口干和张口困难的毒副反应联合照射组比单纯外照射组轻。[结论]Ⅰ、Ⅱ期鼻咽癌患者采用常规外照射联合腔内放疗相对单纯常规放疗有较好的疗效,并可减轻毒副反应。

[Purpose] To investigate long term outcome of nasopharyngeal carcinoma stage Ⅰ and Ⅱ treated with combined external and intracavitary irradiation. [Methods] Four hundred fifty-three cases with nasopharyngeal carcinoma Ⅰ and Ⅱ stage were randomly divided into two groups： external radiotherapy alone group（n=297）, conventional irradiation in total doses of 66-74Gy with lead block fitful fields; combiniation radiation group（n=156）, same external irradiation in total doses of 58-62Gy and intracavitary irradiation with 15-20Gy dose. [Results] In external radiotherapy alone group and combiniation group, 5 years local control rate of stage Ⅰ was 92.86% and 96.43%（P=0.35）; stage Ⅱ, 89.02% and 94.53%（P=0.01） respectively. Five years survival rate of stage Ⅰ was 88.10% and 92.86%（P=0.27）; stage Ⅱ was 81.18% and 90.63%（P=0.03） respectively. Mouth dryness and difficultly opening were less occurred in combination group. [Conclusion] Nasopharyngeal carcinoma patients stage Ⅰ and Ⅱ treated with combined external and intracavitary radiotherapy have better response and less toxicity than those treated with conventional external radiotherapy alone.