螺旋断层放疗鼻咽癌2年经验总结

Two-year experiences in treatment of nasopharyngeal carcinoma with helical tomotherapy

目的总结解放军总医院螺旋断层放疗鼻咽癌的2年临床经验及近期结果。方法 2007年9月-2009年9月间收治73例初治鼻咽癌患者,其中单纯放疗24例,同步综合治疗49例。处方剂量:原发灶及转移淋巴结计划靶区70-74Gy/33F,高危计划靶区60-62.7Gy/33F,低危计划靶区52-56Gy/33F。根据RTOG/EORTC标准评价急性反应。结果平均出束治疗时间为468.8s。放疗急性反应发生率:皮肤0级2.7%,1级76.7%,2级13.8%,3级6.8%;口腔黏膜0级1.4%,1级32.9%,2级60.2%,3级5.5%;口干0级4.0%,1级45.3%,2级50.7%。口干症随时间逐渐缓解,至放疗结束后1年无≥2级口干。同步化疗显著增加了急性反应。放疗结束1月时,鼻咽原发病灶及颈部转移性淋巴结消退率分别为91.8%和98.1%。中位随访时间14.8个月。2例患者放疗结束后肿瘤局部复发,2例患者出现远处转移。1年无复发生存率、无远处转移生存率及总生存率分别为95.6%、97.2%和94.8%。结论鼻咽癌螺旋断层放疗是一种高效、安全、有效的治疗方式。

Objective To summarize the experience in treatment of nasopharyngeal carcinoma（NPC） with helical tomotherapy in our hospital.Methods Of the 73 NPC patients admitted to our hospital from September 2007 and September 2009,24 were treated with simple tomotherapy,49 were treated with combined tomotherapy and medical therapy.The tomotherapy dose was 70–74Gy/33F for primary tumor and metastatic lymph node target region,60–62.7Gy/33F for high risk target region,and 52–56Gy/33F for low risk target region,respectively.Acute side-effects were evaluated following the established RTOG/EORTC criteria.Results The average beam-on time was 468.8s.The incidence rate of skin toxicity was 2.7%,76.7%,13.8% and 6.8%,respectively for grades 0-3.The incidence rate of oral mucositis was 1.4%,32.9%,60.2% and 5.5%,respectively for grades 0-3.The incidence rate of xerostomia was 4.0%,45.3% and 50.7%,respectively for grades 0-2.Xerostomia relived gradually with time and no grade 2 or higher xerostomia was noted one year after tomotherapy.Combined tomotherapy and chemotherapy significantly increased the incidence of severe acute side effects.One month after tomotherapy,the remission rate of NPC and lymph node metastasis was 91.8% and 98.1%,respectively.The median follow-up was 14.8 months.Two patients had a local recurrence and 2 patients developed distant metastasis.The relapse-free survival,distant metastasis-free survival and one-year overall survival rates were 95.6% 97.2% and 94.8%,respectively.Conclusion As a curative treatment modality,helical tomotherapy is effective and safe for NPC.