125例鼻咽癌后程三维适形放射治疗失败病例原因分析

Failure Analysis of three dimensional conformal radiotherapy in the treatment of 125 primary nasopharyngeal carcinoma patients

目的分析初治鼻咽癌患者后程三维适形放射治疗后部分病例治疗失败的原因,以指导今后治疗。方法对1999年1月至2007年12月在本院接受后程三维适形放疗的125例鼻咽癌病例进行回顾性分析,计算局部控制率、无远处生存率、无瘤生存率及总生存率,分析患者治疗后出现死亡、复发、转移的原因。结果 3年、5年、10年局部区域控制率分别为98%、95%、94%。3年、5年、10年无远处转移生存率分别为96%、94%、86%,总生存率分别为93%、86%、78%。全组死亡18例(其中10例死于远处转移,1例死于局部复发,2例死于远处转移及局部复发,2例死于鼻咽大出血,2例死于放射性脑病后反复吸入性肺炎致肺衰竭,1例脑出血死亡)。鼻咽原发灶及颈部淋巴结区域复发6例,3DCRT野内复发4例,野边缘复发2例。结论初治鼻咽癌采用后程三维适形放疗能取得较好的治疗疗效。患者治疗失败的主要原因为肿瘤靶区范围不足、放疗计划设计不周全、出现远处转移,如综合多种影像技术,提高阅片能力,给予准确的射野设计,及放化疗结合有望减少治疗的失败。

Objective To analyze the failure causes of three dimensional conformal radiotherapy（3DCRT）in the treatment of primary nasopharyngeal carcinoma（NPC）patients.Methods 125 patients with primary NPC who received 3DCRT from January 1999 to December 2007 were retrospectively analyzed and the control rate of local,free distant metastasis rate,the tumor-free survival rate and overall survival rate were calculated.Results The 3-,5-and 10-year local control rates were 98%,95% and 94%,respectively;the tumor-free survival rates were 98%,97%,89%,respectively.The overall survival rates were 93%,86% and 76%,respectively.18 patients were dead（10 died of distant metastases,1 died of nasopharyngeal relapse,2 died of diatant metastases and nasopharyngx relapse,2 died of massive hemorrhage in the nasopharynx,2 died of aspiration pneumonia,and 1 died of cerebral hemorrhage）.6 patients developed neck recurrence,concurrent nasopharyngeal relapse nasopharyngeal relapse.4 cases recurrences inside the 3DCRT irradiated field and 2cases were marginal field.Conclusion 3DCRT could obtain better therapy result in the treatment of primary NPC Patients.Main causes of therapy failure were inadequacy for tumor target area,less rigorous on radiothertherapy plan designed and distant metastases.Synthesis more useful imaging techniques,enhancing the capability of correct interpretation of images,accurate design for the radiation and combining radiotherapy and chemotherapy are promising ways to reduce therapy failure.