鼻咽癌颅底骨质破坏颅底补量的临床研究

Clinical study of erosion of the skull base in nasopharyngeal carcinoma with skull base dose boost after radiotherapy

目的探讨鼻咽癌颅底骨质破坏常规放疗后是否需要颅底补量及其方式、时机,以及颅底补量的方式、时机分别与鼻咽癌的局部控制率、生存率的关系。方法回顾性分析2003年7月至2005年6月经病理组织学确诊且鼻咽MRI证实有颅底侵犯的201例局部晚期鼻咽癌患者的临床资料。常规放疗66～70Gy后,21例患者颅底未予补量(A组),97例患者常规颅底补量(B组),54例患者适形补量(C组),29例患者常规放疗2周后适形补量(D组)。169例患者接受以顺铂为基础的新辅助化疗或同期化疗。结果 A、B、C、D组的1年局部控制率分别为96.8%、97.9%、100.0%和100.0%(P=0.688),3年局部控制率分别为80.6%、91.5%、96.4%和78.3%(P=0.117),5年局部控制率分别为77.4%、83.0%、92.9%和78.3%(P=0.394);1年生存率均为100.0%,3年生存率分别为83.9%、93.6%、92.9%和100.0%(P=0.167),5年生存率分别为29.0%、21.3%、57.1%和52.2%(P=0.049);5年放射性脑病的发生率分别为25.8%、27.7%、28.6%和25.4%(P=0.789)。结论颅底骨质破坏的鼻咽癌患者常规根治性放疗后给予颅底适形补量有可能提高5年生存率,且放射性脑病的发生并未因此增加。

Objective To investigate the impact of dose boost in skull base,time point choosing and pattern of dose boost on the local control and survival rate of nasopharyngeal carcinoma（NPC） patients with skull base erosion.Methods Retrospectively analysis was performed on 201 locoregionally advanced NPC patients proved by pathology and found on MRI with skull base erosion.The external radiotherapy dose was 66-70Gy,21 patients received no dose boost（group A）,97 received as conventional dose boost（group B）,54 received as conformal dose boost（group C） and 29 received as conformal dose boost after conventional radiotherapy for 2 weeks（group D）.One hundred and sixty-nine cases received cisplatin-base chemotherapy or neoadjuvant chemotherapy.Results The 1-year local control rates of A,B,C and D groups were 96.8%,97.9%,100.0% and 100.0%（P=0.688）;3-year local control rates were 80.6%,91.5%,96.4% and 78.3%（P=0.117）;5-year local control rate were 77.4%,83.0%,92.9% and 78.3%（P=0.394）,respectively.The 1-,3-,5-year overall survival rate of the 4 groups were all 100.0%;83.9%,93.6%,92.9% and 100.0%（P=0.167）,and 29.0%,21.3%,57.1% and 52.2%（P=0.049）,respectively.The 5-year radiation encephalopathy inciderce rates were 25.8%,27.7%,28.6% and 25.4%（P=0.789）.Conclusion The conformal dose boost in skull base to the locoregionally advanced NPC patients with skull base erosion after radical radiotherapy may improve the 5-year overall survival rate,in addition,there is no increase in radiation encephalopathy.