鼻咽癌外照射加高剂量率后装腔内治疗与单纯外照射治疗的效果比较

The efficacy comparison between the combination of external irradiation with intracavitary brachytherapy of high dose rate and simple radiotherapy for nasopharyngeal carcinoma

比较外照射联合高剂量率后装腔内放疗与单纯外照射治疗的远期疗效及后遗症。对８０例鼻咽癌（Ｔ１～２Ｎ０～１Ｍ０）首程外照射联合高剂量率后装腔内放疗（综合放疗组），配对８０例鼻咽癌（Ｔ１～２Ｎ０～１Ｍ０）同期接受单纯外照射治疗（单纯外照射组）。综合放疗组，外照射剂量为５２～７２Ｇｙ，腔内后装剂量为７～２４Ｇｙ／１～４次，１～２周；单纯外照射组剂量为６６～８２Ｇｙ。结果：综合放疗组与单纯外照射组的鼻咽肿瘤完全消退率分别为９８．８％和９７．５％，差异无显著性（Ｐ＞０．０５）；鼻咽肿瘤局部控制率分别为９５．０％和８３．８％，差异有显著性（Ｐ＜０．０５）；５年生存率分别为８１．３％和７０．０％，差异无显著性（Ｐ＞０．０５）。张口困难发生率综合放疗组低于单纯外照射组（１７．５％对３３．８％，Ｐ＜０．０５）。综合放疗组未发现硬软腭穿孔、溃疡等。认为鼻咽癌外照射结合腔内高剂量率后装治疗，能提高肿瘤局部控制率，减少并发症的发生，而其生存率似有所提高，但差异无显著性。

The efficacy and sequelae comparison of the combination of external irradiation with intracavitary brachytherapy of high dose rate to simple radiotherapy for nasopharygeal carcinoma (NPC) were evaluated. From May 1992 to September 1993, 80 NPC T 1-2 N 0-1 M 0 patients were treated with combined external irradiation plus intracavitary brachytherapy of high dose rate (combination radiotherapy group) and 80 NPC T 1-2 N 0-1 M 0 patients were treated with simple external beam therapy (simple radiotherapy group). In combination radiotherapy group, patients received external beam for 52～72Gy, brachytherapy for 7～24Gy/1～2w at the reference point. For simple radiotherapy group, patients received external beam only with the total dose of 66～82Gy. All patients were followed up for more than 5 years. Patients received combination radiotherapy group had a better local control rate than those of simple radiotherapy group (95.0 % VS 83.8%, P<0.05). The 5-year survival rates were 81.3% and 70.0% in combination radiotherapy group and simple radiotherapy group, respectively, ( P >0.05). Patients received combination radiotherapy had a lower trismus than those of simple radiotherapy group (17.5% VS 33.8%, P <0.05). It could be concluded that external irradiation plus intracavitary brachytherapy can improve local control rate for naso-pharyngeal carcinoma. The 5-year survival rate seems better in combination radiotherapy group than in simple radiotherapy group, statistical difference was not observed. It may cause milder complication in combination radiotherapy group than in simple radiotherapy group.