鼻咽癌超分割合并缩野加量放射的前瞻性随机研究

Hyperfractionated radiotherapy of nasopharyngeal carcinoma with concomitant boost :a prospective randomized trial

目的比较超分割合并缩野加量与常规放射治疗鼻咽癌的局部控制率、生存率和并发症等。材料与方法从１９９０年１０月到１９９２年１月，４８例鼻咽癌患者随机分入超分割合并缩野加量组（研究组）和常规放射组（常规组）。研究组的总剂量为７３～７５Ｇｙ，照射６０次／６周；对照组总剂量为７０．２Ｇｙ，照射３９次／７．５周。总疗程从常规放射的７．５周缩短到６周，总剂量则由７０．２Ｇｙ提高到７４Ｇｙ，获得治疗增益２０％。结果（１）研究组无１例鼻咽部复发而常规组则有６例复发。研究组和常规组的５年局控率分别为１００％和７５．０％（Ｐ＜０．０５）；（２）研究组和常规组的５年生存率分别为６２．５％和５８．３％；（３）研究组的急性粘膜反应明显高于常规组，但能耐受，尚无严重后期并发症发生。结论超分割合并缩野加量治疗鼻咽癌的局控率高于常规放射，且能耐受。

Purpose To compare the local control and survival rates of nasopharyngeal carcinoma treated by hyperfractionated concomitant boost radiotherapy (HCBR) and conventional radiotherapy (CR).Materials and Methods From Oct. 1990 to Jan. 1992, 48 patients with nasopharyngeal carcinoma were randomly divided into two groups: hyperfractionated concomitant boost group (HCBR, 73～75Gy,60F/6 weeks), and the conventional group (CR, 70.2Gy, 39F/7.5 weeks). Radiotherapy of the HCBR shortened treatment time from 7.5 weeks to 6 weeks and delivered the total dose from 70.2Gy to 74Gy, and the therapeutic gain of 20% was obtained calculated by BED.Results (1)No nasopharyngeal recurrence was found in HCBR, but 6/24 in CR, the 5year local control rates in HCBR and CR were 100% and 75.0% (P<0.05),respectively;(2) The 5year survival rates were 62.5% in HCBR and 58.3% in CR.(3)The acute mucosal reaction was more severe inHCBR than in CR.Conclusion Hyperfractionated concomitant boost radiotherapy results in better local control rates than conventional radiotherapy and can be tolerated in nasopharyngeal carcinoma patients.