N_0期鼻咽癌颈部未达诊断标准的肿大淋巴结接受不同照射剂量的疗效比较

Efficacy of suspicious cervical lymph nodes in N_0 nasopharyngeal carcinoma treated with different irradiation doses

目的探讨N0期鼻咽癌颈部未达诊断标准的肿大淋巴结区最佳的照射剂量。方法回顾性分析358例中上颈部存在未达阳性淋巴结诊断标准的N0期鼻咽癌的临床资料,192例的可疑淋巴结区接受52 Gy照射(A组),166例的此区域接受60～64 Gy照射(B组)。采用Kaplan-Meier计算总生存率、无颈部复发生存率和无远处转移生存率,Logrank进行差异检验。结果 T1及T2期,两组的生存率差异无统计学意义,而T3及T4期,B组生存率明显高于A组。B组的T2、T3、T4期的无颈部区域复发生存率明显高于A组,但T1期无明显差异。B组的T3及T4期的无远处转移生存率明显高于A组,而T1及T2期无明显差异。结论 T2、T3、T4N0期患者,若中上颈部存在未达诊断标准的肿大淋巴结,应给予至少60 Gy的照射剂量。

Objective To determine the appropriate irradiation dose for suspicious lymph nodes in N0 nasopharyngeal carcinoma.Methods The data of 358 patients of stage N0 nasopharyngeal carcinoma with suspicious cervical lymph node were retrospectively reviewed.192 cases of suspicious lymph node received 52 Gy irradiation（Group A）,166 cases received 60~64 Gy（Group B）.The survival rates were calculated by Kaplan-Meier method and compared by Logrank test.Results For stage T3 and T4,Group B had significantly higher overall survival rate than Group A.However,the difference of overall survival between two groups for T1 and T2 stages was not significant.The no-neck regional recurrence-free survival rate of Group B for T2,T3 and T4 stages was singnificantly higher than that of Group A.However,the difference between two groups for T1 stage was not significant.The distant metastasis-free survival rate of Group B for T3 and T4 stages was significantly higher than that of Group A.However,the difference between two groups for T1 and T2 stages was not significant.Conclusion The suspicious lymph nodes of patients with stage T2,T3,T4 and N0 nasopharyngeal carcinoma should receive at least the dose of 60 Gy.