116例鼻咽癌一体化照射野调强放疗的疗效分析

Analysis of intensity-modulated radiotherapy on 116 cases of nasopharyngeal carcinoma

目的探讨初诊时无远处转移的鼻咽癌患者应用一体化照射野调强放疗的远期疗效、安全性及预后相关因素。方法收集2005年2月至2008年12月共116例初诊时无转移鼻咽癌患者,根据福州分期：Ⅰ期4例,Ⅱ期22例,Ⅲ期45例,ⅣA期45例。所有患者均接受鼻咽和全颈部一体化照射野调强放疗,具体剂量为：GTVnx 61.32~75Gy,GTVnd 65~80Gy,中位剂量均为70Gy;CTV1 56~60Gy,CTV2 50~52Gy。21例单纯放疗,95例合并化疗,采用以铂类药物为基础的化疗方案。结果随访率100%,中位随访期28个月（6~60个月）。3例局部复发,3例颈淋巴结复发,16例远处转移。1、2、3、4年总生存率及无疾病生存率分别为96%、92%、92%、84%及91%、85%、80%、80%。12例死亡患者中6例死于鼻咽癌远处转移,其余6例死于其他疾病。预后因素分析,临床分期、T分期与3年无疾病生存率、3年无转移生存率明显相关（P〈0.05）。随访满2年的65例患者中,6例出现3级以上口干（9.2%）,4例出现放射性脑病（3.4%）。全组未发现后组颅神经损伤及张口困难病例。结论采用一体化照射野调强放疗技术治疗初诊时无转移鼻咽癌远期疗效较好,副反应发生率低,临床分期、T分期是其预后的相关因素。

Objective To review the clinical outcomes and find out the prognostic factors for nasopharyngeal carcinoma（NPC） patients treated by intensity-modulated radiotherapy（IMRT） technique.Methods One hundred and sixteen cases were enrolled in the study from February 2005 to December 2008.According to Fuzhou staging system,there were 4,22,45 and 45 cases of stage Ⅰ,Ⅱ,Ⅲ and Ⅳ,respectively.All patients received radical IMRT using large field including nasopharynx and full neck to supraclavicle with or without chemotherapy.The prescribed dose for GTVnx,GTVnd,CTV1 and CTV2 was 61.32-75Gy,65-80Gy,56-60Gy and 50-52Gy respectively（median dose of GTV was 70Gy）.Results No patient missed in follow-up.The median follow-up time was 28 months（6-60 month）.Local and regional recurrence occurred in 3 and 3 cases,respectively.Distant metastasis was observed in 16 cases.1-,2-,3-,4-year overall survival and disease-free survival were 96%,92%,92%,84% and 91%,85%,80%,80%,respectively.Six out of 12 patients died of diseases other than NPC.Clinical stage and T stage were significantly correlated to 3-year disease-free survival and 3-year metastasis-free survival（P0.05）.Among the 65 cases with follow-up time more than 2 year,6 cases underwent grade 3 or higher xerostomia.Four cases underwent radio encephalopathy.No patient underwent trismus or lower cranial nerves palsy.Conclusion The IMRT technique provides favorable outcomes with acceptable toxicity in NPC patients.Clinical stage and T stage are correlated factors for prognosis of NPC.