鼻咽癌面颈联合野加后程超分割放疗长期疗效分析

Analysis on Long-term Effect of Facial-cervical Field and Late-course Hyperfractionation Radiotherapy for Nasopharyngeal Carcinoma

[目的]观察鼻咽癌后程超分割放疗长期疗效及毒副反应.[方法]146例鼻咽癌患者随机分为后程超分割治疗组（后超组）和常规分割对照组（常规组）各73例.两组均先行面颈联合野常规分割对穿照射DT36Gy/20次/4周后,后超组：缩野后鼻咽改用超分割照射,每次DT 1.15～1.2 Gy,2次/d,两次放疗间隔时间为6～8 h,每周照射5 d,鼻咽病灶总DT 74.8～776.7Gy/54次/7.5周;对照组73例缩野后常规外照射,DT 2.0 Gy/次/d,鼻咽病灶总DT 69～72 Gy/37～38次/7.5周.颈部均为常规照射.[结果]后超组和常规组鼻咽部肿瘤完全消退率分别为98.3%、96.6%（P〉0.05）;、3、5、8、10年两组肿瘤局部控制率分别83.3%、75.1%、72.8%、72.8%和71.7%、60.9%、52.2%、52.2%（P〈0.05）; 3、5、8、10年的生存率分别为84.9%、68.3%、51.4%、47.8%和78.1%、42.5%、32.9%、30.8%,两组差异有显著性（P〈0.05）.两组放射治疗急性毒副反应,后超组口腔黏膜反应与常规组差异无显著性（P〉0.05）.远期并发症两组相似.复发与转移：常规组放疗后复发（33.7%）高于后超组（21.9%）,两组间比较差异有显著性（P〈0.05）.常规组放疗后（30.14%）出现转移高于后超组（24.65%）,但两组间比较差异无显著性（P〉0.05）.[结论]鼻咽癌后程超分割的局部控制率及长期生存率明显高于常规组,常规放疗组复发率高于后超组,但转移率无差别.后程超分割治疗急性毒性反应及后期副反应均无明显差别,患者能耐受,疗效优于常规放射治疗.

[Objeetive]To observe the long-term effect and side reaction of facial-cervical field and late-course hyperfraetionation radiotherapy for nasopharyngeal earcinoma（NPC）. [Methods] Totally 146 NPC patients were divided into late-course hyperfractionation radiotherapy group and conventional fractionation group with 73 cases in each group. Both groups were treated with facial-cervical field and routine fractionation radiation with the dose of 36Gy for 20 times in 4 weeks. Then late-course hyperfractionation radiotherapy group reduced the field and turned to receive hyperfractionation radiotherapy with 1.15- 1.2Gy for twice daily for 5 days in a week, and the interval time of the radiotherapy was 648 h. The total dose was 74.2-76.7Gy for 54 times in 7.5 weeks. The control group reduced the field and received routine radiation with a dose of 2.0Gy once a day. The total dose was 69-72Gy for 37 or 38 times in 7.5 weeks. The cervical part received routine radiation. [Results] The complete regression rate in the nasopharynx was 98.3% in the late-course hyperfractionation radiotherapy group and 96.6% in the conventional fractionation group（ P 〉0.05）. The 3-, 5-, 8- and 10-year local control rates were 83.3 %, 75.1%, 72.8% and 72.8% in the late-course hyperfractionation radiotherapy group and 71.7%, 60.9%, 52.2% and 52.2% in the conventional fractionation group, and there was significant difference between two groups（ P 〈0.05）. The 3-, 5-, 8- and 10-year survival rates were 84.9%, 68.3%, 51.4% and 47.8% in the late course hyperfractionation radiotherapy group and 78.1%, 42.5%, 32.9% and 30. 8% in the conventional fractionation group, and there was significant difference between two groups（ P 〈0.05）. There was no significant difference in acute side effects such as oral mucous response between two groups（ P 〈0.05）. The long-term complications of two groups were similar. The relapse rate of the conventional fractionation group Was 33.7% which was higher than that of late-course hyperfractionation radiotherapy group（21.9 %）, and there was significant difference between two groups（ P 〈0.05）. The metastasis rate in the conventional fractionation group was 30. 14% which was higher than that in the late-course hyperfractionation radiotherapy group（24.65 %）, and there was no significant difference between two groups（ P 〈0.05）. [Conclusion] The local control rate and survival rate of NPC treated by late-course hyperfractionation radiotherapy are higher than those by conventional fractionation. The recurrence rate of NPC treated by conventional fraetionation is higher than that by late-course hyperfractionation radiotherapy, but there is no significant difference in the metastasis rate between two groups. The acute side reaction and long-term side reaction of late-course hyperfractionation radiotherapy have no obvious difference, and patients can tolerate them. The effect of late-course hyperfractionation radiotherapy is better than conventional fractionation radiotherapy.