335例鼻咽癌根治性放疗后晚期反应分析

Late Toxicities After Definitive Conventional Radiotherapy for Nasopharyngeal Carcinoma:A Retrospective Analysis of 335 Patients in a Single Institute

目的分析我院鼻咽癌患者根治性常规放疗后长期生存情况和晚期反应。方法我院335例经病理证实为鼻咽癌的初治患者均接受根治性常规放疗,57.0%的患者接受顺铂+氟尿嘧啶为主的化疗。观察并记录患者的长期生存情况和晚期反应。结果随访率92.2%,中位随访时间55(1～104)个月。全组5年总生存率、无进展生存率、无复发生存率、无远处转移生存率分别为71.4%、61.3%、66.2%、65.9%。主要晚期反应为口干燥症(100.0%)、颈部纤维化(92.5%)、张口受限(71.0%)、听力缺失(65.1%)、龋齿与牙脱落(39.4%)、吞咽困难(35.8%)、声音改变(26.9%)。放射性脑病、后组脑神经损伤的独立影响因素分别为原发灶剂量、T分期。合并皮肌炎、放疗后鼻咽肉瘤、放疗后甲减各2例。第2原发癌1例。结论我院鼻咽癌患者根治性常规放疗后各主要生存指标与同时期国内不同地区各大肿瘤中心报道的结果相似,原发灶接受较高剂量照射和(或)T分期较晚者应特别注意放射性脑病的发生。

Objective To summarize the survival of nasopharyngeal carcinoma after definitive conventional radiotherapy and the late toxicities in a single institute. Methods The 335 patients with histologically proven nasopharyngeal carcinoma were treated with definitive conventional radiotherapy, and 57.0% of the 335 patients were given with the cisplatin plus fluorouracil chemotherapy. The survival and late toxicities were observed. Results The follow-up rate was 92.2%, the median follow-up time was 55 months （ 1-104 months）. The 5-year overall sur- vival rate, progression-free survival rate, relapse-free survival rate and distant metastasis-free survival rate were 71.4%, 61.3%, 66.2% and 65.9%, respectively. The most common late radiation-related complications were xerostomia （ 100.0% ）, fibrosis （92.5%）, trismus （71.0%）, hearing loss （65.1%）, dental caries and mouth extraction （39.4%）, dysphagia （35.8%）, voice changes （26.9%）. The independent prognostic factors for radiation encephalopathy and radiation-induced lower cranial neuropathy were the dose to primary site and the T-staging. Conclusion Treatment results of definitive conventional radiotherapy for nasopharyngeal carcinoma in our institute were similar with the other centers at the same period, radiation encephalopathy should be prevented and treated in patients with higher dose to primary site and （or） advanced T-staging.