T_3T_4期鼻咽癌两种推量放疗的近期疗效分析

Analysis of short-term efficacy of boost radiotherapy for T_3 and T_4 Stage nasopharyngeal carcinoma patients

目的探讨伽玛刀和三维适形放疗推量放疗治疗局部晚期鼻咽癌的近期疗效。方法选择局部晚期(T3T4期)鼻咽癌患者120例,随机进入伽玛刀推量组(伽玛刀组)40例、3D-CRT推量组(3D-CRT组)40例、调强放射治疗(IMRT)组40例。IMRT组患者采用IMRT技术,鼻咽部大体肿瘤靶区(GTVnx)和其临床靶区(CTV1)的处方剂量分别为76Gy～78Gy和64Gy;颈部转移淋巴结(GTVnd)和其临床靶区(CTV2)的处方剂量分别为64Gy～72Gy和60Gy。伽玛刀组和3D-CRT组患者接受相同方式的常规外照射,鼻咽部剂量为70Gy,针对鼻咽原发灶进行推量治疗,研究组用伽玛刀推量治疗6Gy～10Gy,对照组用3D-CRT推量治疗6Gy～10Gy。结果放疗后3个月和6个月的肿瘤完全消退率与推量方式有关系,差异有统计学意义(P<0.05、P<0.01),伽玛刀组明显优于IM-RT组和3D-CRT组;口干、放射性外耳炎、失眠等放疗急性不良反应与推量方式有关系,差异有统计学意义(P<0.01),IMRT组的放疗急性不良反应明显低于伽玛刀组和3D-CRT组;伽玛刀组的放射性外耳炎和失眠的发生率分别为15.0%和12.5%,明显低于3D-CRT组的35.0%和37.5%,其差异有统计学意义(P<0.05、P<0.01)。结论常规放疗+伽玛刀推量治疗局部晚期鼻咽癌可以提高肿瘤完全消退率,有可能提高局部控制率,减少放射治疗的并发症。

Objective to study the clinical outcomes of the locally advanced nasopharyngeal carci- noma （NPC） patients received boost radiotherapy by either gamma knife or 3D-CRT compared with intensity modulation radiation （IMRT）. Methods 120 locally advanced （T3 or Tn ） NPC patients were random allo- cated into gamma knife boost group （gamma knife group）, 3D-CRT boost group （3D-CRT group）, or IM- RT group. There were 40 patients in each group. Patients in IMRT group received IMRT treatment. DTs de- livered to GTVnx, CTV1, GTVnd, and CTV2 were 76Gy-78Gy, 64Gy, 64Gy-72Gy, and 60Gy, respective- ly. Before boost, patients in gamma knife group and 3D-CRT group received conventional radiotherapy. DT for nasopharyngeal was 70Gy. 6Gy-10Gy were boosted to nasopharyngeal with gamma knife or 3D-CRT ac- cording to their groups. Results complete response rate in gamma knife group was higher than IMRT group or 3D-CRT group. The differences were significant （P 〈 0. 05, P 〈 0. 01 ）. Acute side effects such as dry- ness, otitis external, insomnia were significantly different among the groups （P 〈 0. 01 ）. Acute side effects in IMRT group were lower than gamma knife group and 3D-CRT group. The incidence rates of otitis external and insomnia were 15.0% and 12. 5% which were significant lower than 35.0% （P 〈 0.05） and 37.5% （P 〈 0. 01 ） in 3D-CRT group. Conclusions gamma knife boost combined with conventional radiotherapy for locally advanced NPC patients could improve complete response rate. It may develop locally control rate as well as decrease radiation side effects.