立体定向放射外科治疗鼻咽癌的初步应用

Preliminary application of stereotactic radiosurgery in the treatment of nasopharyngeal carcinoma

目的探讨立体定向放射外科（ＳＲＳ）在鼻咽癌治疗中应用的可行性及价值。方法１９９６年８月至１９９７年１２月用Ｘ－刀治疗鼻咽癌１３例，其中初治者６例，复发者７例。初治者结合外照射７０～７５Ｇｙ，Ｘ－刀靶区周边剂量为１７～２２．５Ｇｙ（中位剂量１８Ｇｙ）。复发者中行外照射加Ｘ－刀３例，Ｘ－刀多次治疗４例，其中行２次者３例，４次者１例。靶区周边剂量为１８～３０Ｇｙ（中位剂量２４Ｇｙ）。结果初治者局控率为８３．３％（５／６）。复发者局控率为７１．４％（５／７）。初治者全部存活，中位生存期１１个月。复发者存活２例，死亡５例，中位生存期７个月。结论ＳＲＳ为提高鼻咽癌治疗的局控率，降低后期并发症发生率提供了安全有效的途径。确切评价ＳＲＳ在鼻咽癌治疗中的作用尚需累积更多的病例资料，进行较长期的观察研究。

Objectives To evaluate the feasibility and value of stereotactic radiosurgery in the treatment of nasopharyngeal carcinoma. ]Methods Thirteen patients with nasopharyngeal carcinoma were treated with linacbased stereotactic radiosurgery (SRS) between August 1996 and December 1997. After or before doses of 7075 Gy external irradiation, these previously untreated patients (6 cases) received SRS boosts of 1722.5 Gy (mean 18 Gy) to the tumor margin. In the recurrent patients (7 cases), three were treated with external irradiation and SRS, four underwent multiple SRS. Of the latter, three were treated 2 fractions and one treated 4 fractions. Dose to the periphery of the tumor in recurrent patients ranged from 1830 Gy (mean 24 Gy). Results Five of 6 previously untreated patients were controled within the boost volume, one patient developed local recurrence 7 months after SRS. Three of 7 recurrent patients studied decreased in size, 2 unchanged, and 2 local failure. All previously untreated patients were a Radio therapylive, median survival after SRS for these patients was 11 months. Median survival for recurrent patients was 7 months, with 2 patients still living. Conclusions SRS can provide a safe and effective approach to improve the local control and reduce the late complications. Longer followup and increased clinical experience will be necessary to evaluate the overall role of SRS in nasopharyngeal carcinoma.