鼻咽癌调强放疗89例临床疗效观察

Therapeutic effect of intensity-modulated radiotherapy on nasopharyngeal carcinoma in 89 patients

目的分析调强放疗(intensity modulated radiation therapy,IMRT)治疗鼻咽癌的疗效。方法对我科2007年10月-2010年10月收治的89例鼻咽癌病人经IMRT治疗,Ⅰ期14例、Ⅱ期46例、Ⅲ期28例、Ⅳa期1例。鼻咽肿瘤靶体积(grosstarget volume,GTV)放疗至60-65Gy时根据肿瘤退缩情况,缩野加量至70-75Gy。中下颈65-70Gy,锁骨上区52Gy,危机器官剂量在安全限制范围内,脑干脊髓平均剂量36.5Gy,左、右视神经47.2Gy、43.4Gy,左右腮腺剂量40.1Gy、39.6Gy,50%腮腺体积平均受照剂量<30Gy。结果中位随访期34个月,7例出现局部或淋巴结复发,1年、2年局部复发率分别为2.2%、6.7%。1年、2年、3年总生存率分别为98.9%、96.6%和93.2%。急性反应主要为口腔黏膜放射性损伤、骨髓抑制、口干。口腔黏膜Ⅰ度损伤19.1%,Ⅱ度、Ⅲ度损伤分别为49.4%、31.4%。骨髓抑制Ⅰ级发生率47.2%,Ⅱ级16.9%,Ⅲ级20.2%。未发现放射性脑损伤后遗症。结论 IMRT对于鼻咽癌各区均有较好的剂量分布,局部控制率和2年、3年总生存率有明显提高,为鼻咽癌标准的治疗方式。

Objective To analyze the effect of intensity-modulated radiotherapy（IMRT） on nasopharyngeal carcinoma.Methods Eighty-nine patients with nasopharyngeal carcinoma（14 at stage Ⅰ,46 at stage Ⅱ,28 at stage Ⅲ,and 1 at stage Ⅳ a） admitted to our hospital from October 2007 to October 2010 underwent IMRT at the dose of 60-65Gy for the gross tumor volume（PTV） of nasopharyngeal carcinoma,which was increased to 70-75Gy according to the reduced PTV of nasopharyngeal carcinoma.The dose of IMRT was 65-70Gy,52Gy,36.5Gy,47.2Gy or 43.4Gy,40.1Gy or 39.6Gy,and 30Gy,respectively,for nasopharyngeal carcinoma at middle and low neck,supraclavicular area,brainstem and spinal cord,left or right optic nerve,left or right parotid,and 50% of parotid.Results The median follow-up time of patients was 34 months.Local or lymph nasopharyngeal carcinoma reoccurred in 7 patients.The 1-and 2-year local recurrent rate of nasopharyngeal carcinoma was 2.2% and 6.7%,respectively.The 1-,2-and 3-year survival rate of the patients was 98.9%,96.6% and 93.2%,respectively.The main acute reactions in the patients were radiation injury of oral mucosa,bone marrow suppression and xerostomia.Radiation injury of oral mucosa at gradesⅠ,Ⅱ and Ⅲ accounted for 19.1%,49.4% and 31.4%,respectively.Bone marrow suppression at gradesⅠ,Ⅱ and Ⅲ was 47.2%,16.9% and 20.2%,respectively.No sequel of radiation cerebral injury was observed in all patients.Conclusion IMRT can achieve satisfactory dose distribution in different areas of nasopharyngeal carcinoma and improve its local control rate and 2-and 3-year survival rate,and is thus a standard treatment modality for nasopharyngeal carcinoma.