鼻咽癌后程三维适形放疗与常规分割放疗的临床研究

A clinical study of late course three dimensional conformal radiotherapy and conventional fractionation for nasopharyngeal carcinoma

目的探讨后程三维适形放疗(3D-CRT)与常规分割放疗(CF)治疗鼻咽癌的疗效和毒副反应。方法将符合入组条件的62例鼻咽鳞癌患者随机分为CF组和3D-CRT组各31例。两组均采用双侧面颈联合野对穿照射,200cGy/次,5次/周,鼻咽部剂量达36～40Gy后改为小面颈野或耳前野对穿避开脊髓继续照射;CF组继续用原分割方案照射至鼻咽部总量66～70Gy,3D-CRT组照射50Gy后改用三维适形放射治疗,3.5～4Gy/次,4次/周,连续5～6次,总剂量达76～81Gy。颈部淋巴结转移灶照射到68～70Gy,预防照射50Gy。结果 3D-CRT组及CF组3、5年原发灶控制率分别为94%、74%和81%、48%(χ2=4.94,P=0.029);生存率分别为90%、77%和81%、52%(χ2=4.80,P=0.032)。两组急性毒副反应及放射后遗症发生率差异无显著性(χ2=0.34、0.08,P=0.577、0.778)。结论后程三维适形放疗与常规分割放疗相比,提高了鼻咽癌3、5年局部控制率及生存率,而未增加急性毒性反应和放疗后遗症。

Objective To evaluate the clinical efficiency and toxicity of late-course three dimensional conformal radiation therapy（3D-CRT） and conventional fractionation （CF）for nasopharyngeal carcinoma patients. Methods 62 patients with squamous cell carcinoma of nasopharyngeal were randomized into late-course 3D-CRT group and CF group, 31 patients in each group. Patients were treated by conventional radiotherapy with 36-40Gy on the two lateral opposing facio-cervical field, then followed treated with the small facio-cervical field or the two lateral opposing preauricular field to avoid irradiation the spinal cord, the whole dose was 66-70Gy in CF group. Patients in late-course 3D-CRT group received the same treatment as CF group white the whole dose was 50Gy followed by late-course 3D-CRT protocol（3.5-4Gy/F, 4F/W, totally 5-6F）, the total dose was 76-81Gy. Patients without lymph node metastasiswere given 50Gy to the neck,while 68-70Gy was delivered to node positive groups. Results The local control rates of 3-year, 5-year were 94%, 74% in late-course 3D-CRT group and 81%, 48% in CF group 0,-2--4.94, P=0.029）, the 3-year,5-year survival rates were 90%, 77% in late-course 3D-CRT group and 81%,52% in CF group （χ2=4.80,P=0.032）. Acute toxicity and the incidence of sequelae of radiation showed no difference between two groups （χ2=0.34,0.0g,P=0.577,0.778）. Conclusion Treatment with late-course 3D-CRT able to improve the 3- year, 5- year local control rate and survival rate, yet no increase in acute toxicity and the incidence of sequelae of radiation