191例鼻咽癌颈部半束与全束照射的结果分析

Comparison of half-beam versus whole-beam irradiation on nasopharyngeal carcinoma

目的探讨与全束照射比较,半束照射技术能否提高鼻咽癌患者的区域淋巴结控制率和减少放射性后组脑神经损伤(RILCN)发生率。方法 191例以连续接受根治性放疗的鼻咽癌患者为研究对象,常规分割照射,采用同期非随机对照研究的方法,将患者分为半束照射组(80例)和全束照射组(111例);以Kaplan-Meier法计算生存率、Log-rank检验进行差异检验、Cox比例风险模型和Logistic回归模型进行多因素分析。结果全组5年总生存率为67.3%,半束组与全束组5年总生存率分别为62.3%和67.4%,差别无统计学意义(χ2=0.244,P=0.621);性别和临床分期为预后因素。5年区域淋巴结控制率分别为80.6%和83.1%,差别无统计学意义(χ2=1.425,P=0.237);N分期为其预后因素。半束照射组和全束照射组的RILCN发生率分别为8.8%(7/80)和9.0%(10/111),两组间差别无统计学意义(χ2=0.004,P=0.951)。结论与全束照射相比,半束照射技术未能提高鼻咽癌患者的区域淋巴结控制率和减少放射性后组脑神经损伤发生率。

Objective To explore whether the half-beam irradiation on nasopharyngeal carcinoma （NPC） could increase regional control rate and reduce radiation-induced lower cranial neuropathy （RILCN） compared to the effect of whole-beam irradiation.MethodsIn a non-random concurrent controlled trial,191 NPC patients who received definitive conventional radiation were divided into half-beam irradiation group （n=80） and whole-beam irradiation group （n=111）.Kaplan-Meier method,log-rank test,Cox or Logistic regression model were used respectively to calculate the survival rate,compare the difference between two groups and carry through the multivariate analysis.ResultsThe 5-year overall survival rate （OS） of all patients was 67.3%,while it was 62.3% and 67.4% in half-beam group and whole-beam group respectively,and the difference between the two groups was not significant （χ^2=0.244,P=0.621）.Multivariate analysis showed patient’s gender and clinical stage were independent risk factors of OS.The 5-year regional control rate of half-beam group and whole-beam group were 80.6% and 83.1% respectively,and the difference between the two groups was not significant （χ^2=1.425,P=0.237）.Multivariate analysis showed N stage was independent risk factor for regional control rate.The incidence of RILCN of half-beam group and whole-beam group were 8.8% （7/80） and 9.0% （10/111） respectively,and the difference between the two groups was not significant （χ^2=0.004,P=0.951）.ConclusionsComparing to whole-beam irradiation,half-beam irradiation for NPC has no significant advantage on increasing regional control rate and reducing RILCN rate.