同期加量照射个体化治疗放射抗拒鼻咽癌的初步临床疗效分析

Clinical Effect of Simultaneous Boost Irradiation Radiotherapy for Patients with Radiation-resistant Nasopharyngeal Carcinoma

目的评估同期加量照射治疗放射抗拒鼻咽癌(NPC)的临床价值。方法选择2005～2007年常规放疗至40Gy/20次经CT和/或MR评估鼻咽原发肿瘤病灶,疗效为无变化(MS)的78例放射抗拒的NPC患者,按照T分期配对分为同期加量照射(SBIRT)组和常规剂量照射(CRT)组,分别采用后程2.3Gy/次和2Gy/次常规分割,照射鼻咽原发肿瘤至总剂量67.6～79.1Gy/32～37次/6.2～7.4周和70～78Gy/35～39次/7～7.8周,T3、T4和/或N2期患者在放疗同期接受顺铂+氟尿嘧啶方案化疗2～3个疗程。结果放疗结束时与放疗结束后3个月SBIRT组和CRT组鼻咽原发肿瘤的完全缓解率和部分缓解率分别为61.5%、25.6%和41.0%、33.3%(P<0.05)。SBIRT组和CRT组的1、2、3年无局部复发生存率分别为94.9%、87.2%、74.4%和92.3%、82.1%、66.7%(P=0.0672);1、2、3年总生存率分别为97.4%、82.1%、69.2%和94.9%、84.6%、71.8%(P=0.0965)。急性放射反应主要为咽黏膜炎及口腔干燥,SBIRT组的3/4度粘膜反应发生率略高为30.8%(12/39),晚期的放射损伤主要为咽黏膜萎缩、张口受限、放射性中耳炎和放射性脑病,无严重致死性毒性反应发生,但两组毒性反应的发生率差异均无统计学意义(P>0.05)。结论放射抗拒NPC患者采用同期加量照射的个体化放射治疗与常规剂量照射的根治性放射治疗相比较整体疗效相当,有提高局部控制率的趋势,而急性和晚期放射损伤发生率基本相似,值得进一步的深入研究。

Objective To assess the dose of radiation therapy Tongqi radiation resistance ofnasopharyngeal carcinoma （NPC） clinical value. Methods Conventional radiation therapy from 2005 to 2007 to 40 Gy/20 times by CT and / or MR assessment of nasopharyngeal primary tumor lesions, efficacy was unchanged （MS） of 78 patients with radiation resistance of NPC patients, according to T stage matching points for the same dose of radiation （SBIRT） group and the conventional dose irradiation （CRT） group, respectively, late course 2.3 Gy / times and 2 Gy / second conventional fractionated irradiation nasopharyngeal primary tumor to a total dose of 67.6 - 79.1 Gy/32 - 37 times / week and 70 - 78 Gy/35 - 39 6.2 - 7.4 times / 7 - 7.8 weeks, T3, T4 and / or N2 Radiotherapy Concomitant of patients receiving cisplatin plus fluorouracil regimen for 2 to 3 courses. Results The end of radiotherapy and 3 months after radiotherapy group and the CRT group SBIRT nasopharyngeal primary tumor complete response rate and partial response rates were 61.5%, 25.6% and 41.0%, 33.3% （P 〈0.05）. SBIRT group and the CRT group of 1, 2, 3-year local recurrence-free survival rates were 94.9%, 87.2%, 74.4% and 92.3%, 82.1%, 66.7% （P= 0. 0672）; 1, 2, 3 year overall survival rates were 97.4%, 82.1%, 69.2% and 94.9%, 84.6%, 71.8% （P= 0.0965）. Acute radiation reactions were mucositis and dry mouth, pharynx, SBIRT Group 3/4 mucositis was slightly higher rate of 30.8% （12/39）, late radiation injury mainly pharyngeal mucosal atrophy, limitation of mouth opening, radiation otitis media and radiation encephalopathy, no serious fatal toxic reaction, but both the incidence of toxicity was no significant difference （P 〉0.05）. Conclusion Radiation resistance in patients with NPC dosage irradiation has the similar curative effect with concurrent radiation therapy and conventional individual dose of radical radiotherapy, which has increased the local control rate trend, and acute and late radiation injury incidence are similar, which is worthy of further study.