121例鼻咽癌螺旋断层治疗结果分析

Clinic results of 121 nasopharyngeal carcinoma patients treated by helical tomotherapy

目的回顾分析本院螺旋断层治疗（HT）的鼻咽癌患者的短期疗效和不良反应。方法2007-2010年间收治121例初治鼻咽癌患者，其中单纯HT31例，HT同期化疗或靶向治疗90例。原发灶及转移性淋巴结计划靶区70～74Gy分33次，高危计划靶区60．0-62．7Gy分33次，低危计划靶区52～56Gy分33次。根据美国放疗肿瘤组织或欧洲癌症研究与治疗组织标准评价急性不良反应。结果鼻咽原发灶、颈部淋巴结转移灶消退率分别为95．0％、99．0％。随访率为100％，随访满1、2、3年者分别为99、49、7例。1、2、3年无局部复发生存率分别为97．3％、97．3％、97．3％，无区域淋巴结复发生存率分别为100％、100％、100％，无远处转移生存率分别为98．4％、96．3％、96．3％，总生存率分别为96．5％、92．6％、86．8％。0、1、2、3级急性不良反应发生率皮肤分别为5．O％、74．4％、15．7％、4．9％，口腔黏膜分别为0．8％、37．2％、57．9％、4．1％，口干分别为3．3％、53．7％、43．0％、0％。HT结束后1年无I〉2级口干。同期放化疗显著增加了黏膜炎及咽食管炎发生率。结论鼻咽癌螺旋断层治疗是一种高效、安全、有效的治疗方式。

Objective To summarize the outcome of nasopharyngeal carcinoma （NPC） treated by helical tomotherapy in the Chinese PLA general hospital. Methods Between September 2007 and August 2010, 121 newly diagnosed NPC patients were treated by radiotherapy with Tomotherapy system, with （n = 90） or without （ n = 31 ） concurrent chemotherapy or molecular target therapy. The prescription dose was 70 -74 Gy/33f to primary tumor and positive lymph node planning target volume ,60. 0 -62. 7 Gy/33f to high risk planning target volume, and 52 - 56 Gy/33f to low risk planning target volume. Acute side-effects were evaluated with RTOG/EORTC criteria. Results The remission rate of primary lesion and positive lymph nodes was 95.0% and 99.0%, respectively. The follow-up rate was 100%. The number of patients with 1, 2 and 3 years fallowed-up were 99, 49, and 7. The 1-, 2-and 3-year local relapse-free survival rates were 97.3% , 97.3% and 97.3% , respectively. The 1-, 2-and 3-year nodal relapse-free survival rates were 100%, 100% and 100%, respectively. The 1-,2-and 3-year distant metastasis-free survival rates were 98.4%, 96. 3% and 96. 3%, respectively. The 1-, 2-and 3-year overall survival rates were 96. 5%, 92. 6% and 86. 8%, respectively. Acute toxicities of skin, oral mucosa and xerostomia with grade 0,1,2 and3 were 5.0%, 74.4%, 15.7% and 4.9%;0.8%, 37.2%, 57.9% and 4.1%;3.3%, 53.7%, 43.0% and 0% , respectively. Xerostomia restored with time, n~ grade 2 or more xerostomia was observed 1 year after radiation therapy. Concurrent chemotherapy significantly increased incidence of mucositis, esophagitis and tracheitis. Conclusion Helical tomotherapy is efficient, secure and effective modality for the treatment of nasopharyngeal carcinoma.