三维适形放射治疗加常规放射治疗鼻咽癌的临床研究

The Therapeutic Effect Of Three-dimensional Conformal Radiation Therapy Combined with Conventional Radiotherapy for Nasopharyngeal Carcinoma

目的探讨三维适形放疗治疗加常规放射治疗鼻咽癌的疗效与优势。方法初次治疗78例鼻咽癌患者,分两阶段对原发灶及颈部放射治疗。第一阶段针对鼻咽部病灶以及颈部转移病灶采用三维适形放射治疗,单次剂量2～5Gy,每周5次,总剂量30Gy。第二阶段T1N0或部分T2N0鼻咽癌患者行两耳前野DT55Gy+前后颈切野照射DT50Gy,颈部中间加一个3cm挡块。颈淋巴结转移患者行面颈联合两侧野照射DT55Gy(40Gy后缩野避开脊髓和脑干)+中下颈前后切野DT55Gy,均为常规分割放疗,射野上界保持与主野下界衔接。结果治疗结束后3个月局部肿瘤(原发灶和颈部淋巴结)完全缓解率、部分缓解率、无变化率以及进展率分别为38.5%、55.1%、5.1%、1.3%,总有效率(CR+PR)为93.6%。肿瘤1、2、3、5年局控率分别为92.3%、88.5%、78.2%、70.5%。1、2、3、5年生存率分别为96.2%、89.7%、83.3%、71.8%。出现的早期放射反应都能耐受,在随访过程中未观察到明显的张口困难或后组颅神经损伤。结论鼻咽癌三维适形放射治疗加常规放射治疗的近远期疗效肯定。

Objective To observe the therapeutic effect of three-dimensional conformal radiation therapy（3DCRT） for nasopharyngeal carcinoma（NPC）.Methods 78patients with NPC was treated by radiation schedule in two phases.In the first phase,nasopharyngeal lesions and metastases of all patients were treated by three-dimensional conformal radiation therapy（3DCRT） with a fraction of 2-5Gy daily,5 day per weeks,total dose 30Gy.The second phase T1N0 or parts of T2N0 patients were done by Conventional radiotherapy with total dose 55Gy on two small lateral opposing fields＋with total dose 50Gy on neck on tangential field,adding a 3cm block.Patients with lymph node metastasis were given 55Gy on the dacio-neck field（After40Gy,two small lateral opposing fields were used to boost the primary tumor while the spinal cord shielded）＋ with total dose 55Gy on lower neck on tangential field.The upper bound of designed therapeutic field was set to connect with lower bound of main therapeutic field.Results Three months after treatment,the rate of CR、PR、SD、PD were 38.5%、55.1%、5.1%、1.3%,Total effective rate（CR＋PR）were 93.6%.The 1-year、2-year 、3-year and 5-year local-regional control rates were 92.3%、88.5%、78.2%、70.5%.The 1-year、2-year 、3-year and 5-year overall survival rate were 96.2%、89.7%、83.3%、71.8%.Appearing early radiation response is well tolerated and no obviously mouth difficulties and cranial nerve damage observed.Conclusion Clinical result of early-course three-dimensional conformal radiation therapy（3DCRT） for nasopharyngeal carcinoma（NPC） is good.