^(60)Co外照射加高剂量率腔内后装放射治疗鼻咽癌长期观察

The long term results of nasopharyngeal carcinoma treated by ^(60)Co external irradiation plus intracavitary radiotherapy using the high dose rate afterloading technique

目的 :分析6 0 Co外照射加高剂量率后装腔内放射治疗鼻咽癌的长期疗效及晚期放射性并发症。材料与方法 :回顾性分析 1 981年 6月至 1 988年 1 2月采用6 0 Co外照射加高剂量率后装腔内放射治疗鼻咽癌 64例。本组病例都随访 5年以上 ,失访者作死亡统计。结果 :本组病例 5年局部控制率为 82 .8% (5 3 /64)。 5年生存率和无瘤生存率分别为 75 .0 % (4 8/64)和 68.8% (4 4 /64)。鼻咽局部复发 6例 ,远处转移 8例、鼻腔骨肉瘤者 1例。晚期放射并发症 ,鼻腔死骨形成 1例 ,软硬腭骨穿孔 4例。结论 :后装腔内放射治疗适当减少鼻咽癌外照射剂量 ,增加鼻咽腔内加量照射。适应于鼻咽早期原发肿瘤和鼻咽癌外照射后鼻咽腔内残留病灶。

Purpose: The long term results and radiation sequelae of nasopharyngeal carcinoma treated by 60 Co external irradiation plus the high dose rate afterloading intracavity radiation (AIR) were analysed.Materials and Methods:From June 1981 to December 1988, 64 patients with nasopharyngeal cacinoma were treated by 60 Co external irradiation plus the high dose rate AIR. The AIR was given as a routine boost or for residual disease. The external irradiation dose varied from 55 to 70 Gy, whereas AIR dose ranged from 10 to 45 Gy. Results: All patients were followed up for mored than 5 years. The 5-year local control rate was 82.8%. The 5-year actuarial survival and disease free rates were 75.0%,68.8% respectively . 8 cases developed distant metastases, 6 cases recurred in the nasopharynx and/or neibouring structures and 1 case ocurred bone sarcoma of hard palate. The late radiation sequelae occured in 4 cases, 1 radiation necrosis of the bone in nasal cavity and 3 radiation perforations in hard and soft palate.Conclusion: We think that AIR for nasopharyngeal carcinoma is indicated for boosting the dose to the nasopharyngeal cavity with appropriated reduction in external irradiation dose ,and for residual disease after primary external radiotherpy. To reduce radiation sequelae applicator should be improved.