加速超分割放射治疗鼻咽癌前瞻性研究的近期结果

A Prospective Trial of Treating Nasopharyngeal Carcinoma (NPC) Patients with An Accelerated Hyperfractionated (AHF) Radiotherapy Regimen: Short Term Results and Reaction

目的：为了探讨加速超分割放射治疗鼻咽癌的临床效果和早、晚期放射反应。方法：１９９５年１月～１９９６年７月首次住院放疗的鼻咽癌患者２６６例。随机分为加速超分割（ＡＨＦ）和常规分次（ＣＦ）对照两组，均经ＣＴ或ＭＲＩ检查及Ｐｌａｔｏ治疗计划系统设计布野。对鼻咽部ＡＨＦ组方案为ＤＴ７９．２Ｇｙ／７２次／２４个治疗日，全程３２天，１．１Ｇｙ／次，每天３次，各次之间间隔＞６ｈ；对照组的方案是ＤＴ７０Ｇｙ／３５次７周，２Ｇｙ／次，每周５次。颈结（＋）给予治疗量，ＡＨＦ组７９．２Ｇｙ，对照组７０Ｇｙ；颈结（－）给予预防量，ＡＨＦ组５０Ｇｙ，对照组４５Ｇｙ。结果：ＡＨＦ组的疗终病灶全消和１年生存率优于对照组，差异有统计学意义。而急性放射反应，则明显重于对照组，皮肤粘膜Ⅲ度放射反应增多。差异非常显著。实验组有１０．７％患者需要短期中断疗程和支持治疗。结论：加速超分割放疗鼻咽癌的近期效果较好，疗终病灶全消率和１年生存率均优于常规分次组（Ｐ＜０．０１和０．０５）。虽然急性放射反应较重，但大多数患者可以耐受。

Purpose:To evaluate the therapeutic effect and reactions of AHF radiotherapy for NPC. Methods:Two hundred and sixty six previously untreated NPC patients were randomly assigned to AHF arm (150 cases)and conventional fractionation arm (CF group,116 cases). All the therapeutic designs were performed on a Plato TPS after CT scanning or MRI. Irradiation dose to the NPC foci were: AHF group 1.1Gy tid up to a total dose of 79.2Gy/72fx,(32 days),and 70Gy/35fx for the CT arm .For neck nodes:50Gy and 45Gy to both groups with negative nodes respectively, and 79.2Gy and 70Gy to patients with positive nodes respectively. Results: AHF group had a higher complete regression rate of tumor and a higher 1 year survival than those of the CF group, but the AHF group had more serious irradiation reactions than the control group. Conclusion: AHF group had better short term therapeutic effect with tolerable reactions in most cases, therefore, adoption of AHF regimen for NPC patients seems justified.