176例鼻咽癌调强放疗晚期不良反应分析

Analysis of late toxicities after intensity-modulated radiotherapy in 176 patients with nasopharyngeal carcinoma

目的 了解鼻咽癌调强放疗的晚期不良反应并分析危险因素。方法 共 299例鼻咽癌首程接受调强放疗,鼻咽及颈部肿瘤处方剂量为70 Gy,亚临床区域剂量为60 Gy,下颈部及锁骨上区预防剂量为54 Gy,5 次/周共30次。分析本院随访的 176例患者资料。危险因素行Logistic法分析。结果 中位随访时间为52个月,随访率为99.7%。最常见不良反应为口腔干燥、听力下降,发生率分别为54.5%、61.4%。0~1级皮肤、皮下或鼻咽黏膜发生率分别为91.5%、93.2%或97.2%。1~2级张口困难发生率为3.4%。严重治疗并发症包括 5例颅神经损伤,2例鼻咽出血（其中 1例因鼻咽大出血而死亡）。影响口干、听力下降危险因素有化疗（χ2=7.38、7.96,P=0.007、0.005）和腮腺中位剂量、内耳中位剂量（χ2=4.09、7.96,P=0.043、0.005）。结论 鼻咽癌调强放疗后大多数只有轻度皮肤、皮下及鼻咽黏膜组织不良反应;除早期病变外,由于放疗剂量和化疗因素使口干、听力下降发生率仍较高。

Objective To investigate the late toxicities after intensity-modulated radiotherapy（IMRT） for nasopharyngeal carcinoma and analyze the risk factors for treatment complications.Methods A total of 299 patients with nasopharyngeal carcinoma were given initial IMRT. The nasopharyngeal lesion and cervical lymph nodes were given a prescribed dose of 70 Gy;the dose was 60 Gy to subclinical region;the prophylactic dose was 54 Gy to the lower neck and supraclavicular region;these doses were given in 30 fractions over 6 weeks. The clinical records of 176 patients followed up were analyzed. The hazard factors were analyzed with Logistic method. Results The median follow-up was 52 months, and the follow-up rate was 99.7%. The most common radiotherapy-induced toxicities were xerostomia and hearing loss, with incidence rates of 54.5% and 61.4%. The incidences rate of grade 0—1 adverse reaction of skin, subcutaneous tissue, or nasopharyngeal mucosa was 91.5%, 93.2%, or 97.2%;the incidence rate of grade 1—2 trismus was 3.4%. Severe complications included cranial nerve injury （5 patients） and epistaxis （2 patients, one dying due to profuse epistaxis）. The hazard factors for xerostomia and hearing loss were chemotherapy （χ2=7.38, P=0.007;χ2=7.96, P=0.005） and median doses to the parotid gland and inner ear （χ2=4.09, P=0.043;χ2=7.96, P=0.005）.Conclusions Most patients develop only mild toxicity of the skin, subcutaneous tissue, or nasopharyngeal mucosa after IMRT. The incidence rates of xerostomia and hearing loss remain high owing to radiotherapy dosage and chemotherapy.