鼻咽癌患者根治性常规放疗后335例生存分析

Effects of Radical Conventional Radiotherapy on Nasopharyngeal Carcinoma:Retrospective Analysis of 335 Patients in a Single Institute

目的总结鼻咽癌患者根治性常规放疗后长期生存情况。方法经病理证实为鼻咽癌、行连续根治性常规放疗的初治患者335例,男女比例为2.28:1,发病中位年龄47岁(15～77岁);Ⅰ,Ⅱ,Ⅲ,Ⅳa及Ⅳb期分别占3.9%,19.4%,35.2%,40.0%及1.5%。直线加速器、低熔点铅挡、常规分割外照射,鼻咽原发灶中位剂量72Gy,每次1.8～2.0Gy,面颈联合野+面颈联合缩野+耳前野三阶段照射。57.0%的患者接受顺铂+氟尿嘧啶1～2周期的诱导化疗和/或1～5周期的辅助化疗。结果随访率92.1%,中位随访时间55月(1～104月)。全组5年总生存率、无进展生存率、无复发生存率、无远处转移生存率、无进展率、区域控制率及无远处转移率分别为71.4%,61.3%,66.2%,65.9%,70.2%,86.6%及79.6%;Ⅰ,Ⅱ,Ⅲ,Ⅳa及Ⅳb期患者5年生存率分别为100.0%,86.2%,75.7%,57.4%及7.0%。发生率较高的晚期损伤依次为口干燥症、颈部纤维化、张口受限、听力缺失、龋齿与牙脱落、吞咽困难、声音改变。放射性脑病、后组脑神经损伤的独立影响因素分别为原发灶剂量(P=0.032)、T分期(P=0.015)。结论对于原发灶剂量大、T分期较晚者应注意防治放射性脑病。

ABSTRACT： Objective To analyze the long-term survival of patients with nasopharyngeal carcinoma who were treated with radical conventional radiotherapy in a single institute. Methods 335 consecutive patients from Nov. 1999 to Dec. 2004, who were histologically proven suffering from nasopharyngeal carcinoma and treated with radical conventional radiotherapy, were retrospectively analyzed. These patients were in a male/female ratio of 2.28 ： 1. The patients ages ranged from 19 to 78 years old （median age of 47 years）. Those with Stage Ⅰ ,Ⅱ ,Ⅲ and Ⅳ （the Fuzhou Staging System, 1992） were 3.9%, 19.4%, 35.2%, 40.0% and 1.5%, respectively. All patients were given radical external beam irradiation. Results The follow-up rate was 92. 1%, with a median follow-up time of 55 months （1 - 104 months）. The 5-year actual overall survival rate （OS）, progression -free survival rate （PFS）, relapse- free survival rate （RFS）, distant metastasis-flee survival rate （DMFS）, progression-free rate （PFR）, locoregional control rate （LRCR） and distant metastasis-free rate （DMFR） were 71.4%, 61.3%, 66.2%, 65.9%, 70.2%, 86.6% and 79.6%, respectively. The 5-year OS rates were 100.0%, 86.2%, 75.7%, 57.4% and 7.0% for patients with Stage Ⅰ , Ⅱ , Ⅲ, Ⅳa and Ⅴb, respectively. The injuries in advanced stage with high incidence included such radiation-related complications as xerostomia, fibrosis, trismus, hearing loss, dental caries and mouth extraction, dysphagia, and voice changes in sequence. The inde- pendent prognostic factors for radiation eneephalopathy （RE） and radiation-induced lower cranial neuropathy （RILCN） were the total radiation dose to primary site （P=0. 032） and the T-staging （P=0. 015）. Conclusions The effects of radical conventional radiotherapy on NPC in our institute are similar to those present in other centers of the same period. RE should be prevented and treated in patients given higher dose to primary site and/or of advanced T-staging.