后程同期小野加量放射治疗鼻咽癌的临床研究

Later Course Small Field Boost Radiotherapy for Nasopharyngeal Carcinoma

目的探讨后程同期小野加量放射治疗鼻咽癌的临床疗效及副作用。方法对经放疗(DT50Gy)后疗效为PR、SD、PD的250例鼻咽癌患者,随机分为常规分割放疗组(对照组)及后程同期小野加量放射治疗组(研究组)。结果治疗结束时,研究组和对照组原发灶CR、PR率分别为33.60%、66.40%和22.40%、77.60%(P<0.05),放疗后3～6个月,研究组和对照组原发灶CR、PR率分别为42.40%、57.60%和29.60%、70.40%(P<0.05);研究组和对照组1、3、5年原发灶局部控制率分别为97.60%、83.20%、79.20%和95.20%、75.20%、68.00%(P<0.05);研究组和对照组的1、3、5年生存率分别为97.60%、76.80%、59.20%和93.60%、67.20%、46.40%(P<0.05);研究组急性放射反应与对照组比较无明显差异(P>0.05),晚期放射损伤相同。结论对放射治疗肿瘤消退较小鼻咽癌患者,予后程同期小野加量放射治疗的疗效高于常规放疗,且毒副作用无明显增强。

Objective To explore the curative effects and side effects of later course small field boost radiotherapy for Nasopharyngeal carcinoma （NPC）. Methods 250 NPC patients were randomized into later course small field boost radiotherapy group （ the study group） and conventional radiotherapy group （ the control group） after 50 Gy radiotherapy. Results After the treatment, the CR and PR rates in the study group and the control group was 33.60%, 66.40% and 22.40% ,77.60% respectively （ P 〈 0.05 ）. The CR and PR rates of the two groups was 42.40% ,57.60% and 29.60% ,70.40% respectively 3 - 6 months after radiotherapy. The 1,3,5-year local control rates of the two groups were 97.60 % ,83.20 % ,79.20% and 95.20 % , 75.20 % and 68.00 % （P 〈0.05）. The 1,3,5-year survival rates of the two groups were 97.60 % ,76.80 % ,59.20% and 93.60% ,67.20% ,46.40% respectively（ P 〈 0.05 ）. There were no statistically significant difference in acute and late side effects between the two groups. Conclusion Later course small field boost radiotherapy may improve the local control and surviv- al rates without significantly increasing the side effects for patients with relatively radio -resistant nasopharyngeal carcinoma.