30例早期鼻咽癌调强放射治疗疗效分析

Efficacy of 30 early nasopharyngeal carcinoma patients treated with intensity modulated radiotherapy

目的:探讨调强放射治疗(IMRT)对早期鼻咽癌的近期疗效和不良反应。方法:回顾分析30例早期鼻咽癌患者,鼻咽部和上颈部淋巴引流区采用IMRT技术照射,下颈部淋巴引流区采用颈前野常规照射。鼻咽大体肿瘤体积(GTVnx)处方剂量68Gy-74Gy,颈部淋巴结(GTVnd)处方剂量64Gy-70Gy,临床靶体积(CTV1)处方剂量60Gy-64Gy,临床靶体积(CTV2)处方剂量50Gy-54Gy,分30-34次进行照射。对于淋巴结分期为N1的患者,结合淋巴结的情况行诱导化疗和(或)同期化疗2-4周期,N0患者行单纯调强放射治疗。结果:鼻咽大体肿瘤体积(GTVnx)D95平均剂量为74.5Gy,GTVnx V95平均体积99.6%,脊髓D1cc平均剂量41.5Gy,脑干D3平均剂量50.3Gy,左腮腺D50平均剂量32.8Gy,右腮腺D50平均剂量31.4Gy,左颞叶D10平均剂量45.5Gy,右颞叶D10平均剂量45.2Gy,均低于限制剂量。中位随访时间33.5个月(4-45个月)。1年、2年、3年的总生存率、无局部复发生存率和无远处转移生存率均为100%。最严重的急性反应是放射性黏膜炎,1-3级分别有63.3%,30%,和6.7%,晚期不良反应主要表现为口干(Ⅰ度33.3%,Ⅱ度3.7%)。结论:IMRT对初治早期鼻咽癌可获得理想的剂量分布,取得较好的近期疗效,正常组织得到很好的保护。

Objective：To approach the curative effect and side effect of intensity modulated radiationtherapy（IMRT） for early-stage nasopharyngeal carcinoma（NPC）.Methods： Total of 30 early NPC patients were treated and studied retrospectively.The nasopharynx and upper neck were irradiated by IMRT technique.The lower neck and the supraclavicular fossae were irradiated with the conventional technique uising an anterior field.The prescription dose was engaged to the goss target volume（GTVnx） of nasopharyngeal to DT 68-74Gy/30-34f.Positive neck lymph nodes（GTVnd） to DT 64-70Gy/30-34f.Clinical target volume（CTV1） to DT 60-64Gy/30-34f and CTV2 to DT 50-54Gy/30-34f.For some patients with N1 disease,they were treated with induction chemotherapy and（or） concurrent chemotherapy in 2-4 periods.And the stage N0 NPC patients had received IMRT alone.Results： The average mean of D95,V95 to the GTVnx was 74.5Gy,99.6%.The average dose to 1cm3 spinal cord（D1cc）,3 percent of brain stem volume（D3）,50 percent of left parotid gland volume（D50）,50 percent of right parotid gland volume,10 percent of left temporal lobe volume（D10）,10 percent of right temporal lobe volume were 41.5Gy,50.3Gy,32.8Gy,31.4Gy,45.5Gy and 45.2Gy.All of the mean dose to the surrounding organs were allowed.Median follow-up was 33.5 months（4-45months）.The 1 year,2 year and 3 year overall survival rates,local control rates and distant metastase-free rates all were 100%.The most serious acute toxicity was mucositis,63.3% in grade 1,30% in grade 2,6.7%in grade 3.The late toxicity was mostly salivary gland with grade Ⅰ 33.3%,Ⅱ3.7%.Conclusion： In the treatment of early-stage NPC,intensity modulated radiation therapy makes good dose distribution and protect the normal tissue,then get a better curative effect.