41例初治鼻咽癌调强放疗急性不良反应临床观察

The Observation of Acute Adverse Reaction of IMRT for the First Treatment of 41 Cases with Nasopharyngeal Tumor

目的:观察调强放疗(intensity modulated radiation therapy,IMRT)对初治鼻咽癌的近期临床疗效急性毒性反应。方法:41例初治鼻咽癌患者中,按92福州分期标准,Ⅰ期1例,Ⅱ期4例,Ⅲ期13例,Ⅳ期23例;1例仅接受根治性调强放疗,其余40例均接受放化综合治疗。鼻咽大体肿瘤体积(GTVnx)处方剂量为(68～70)Gy分30～33次,颈部淋巴结(GTVnd)处方剂量为(62～66)Gy分30～33次,临床靶体积1(CTV1)(60～64)Gy分30～33次,临床靶体积2(CTV2)(50～54)Gy分30～33次。病灶靶区处方剂量为68～70 Gy。对于鼻咽癌Ⅱ、Ⅳ期患者,IMRT治疗的同时,根据淋巴结转移,以及患者的基本情况,酌情给予奈达铂+5-Fu,进行1～2周期的诱导化疗,以及单药奈达铂的同步化疗。根据RTOG/EORTC标准,对其急性反应进行评估。结果:中位随访时间1～13个月,多数患者仅表现为1～2级急性反应,观察到4级急性反应1例。1年随访期间,局部区域进展、远处转移,以及总生存率分别为95.1%、95.1%和100.0%。结论:对于早期或晚期鼻咽癌患者,IMRT均可获得理想的剂量分布,最大可能地保护正常组织,提高患者对毒副反应的耐受力,明显提高治疗的临床效果。远期疗效需进一步观察。

Objective： To evaluate the clinical efficacy and acute toxicological reactions of intensity modulated radio therapy（IMRT） for nasopharyngeal cancer patients.Methods： Among 41 cases of nasopharyngeal carcinoma patients,according to the 92 Fuzhou staging criteria,1 case in stageⅠ,4 cases in stage Ⅱ,13 cases in stage Ⅲ,23 cases in stage Ⅳ.1 patient received intensity modulated radiationtherapy alone,and 40 patients treated by radiotherapy combined with chemotherapy.Nasopharyngeal gross tumor volume（GTVnx） prescription dose for（68～70） Gy/30～33f,cervical lymph node（GTVnd） prescription dose（62～66） Gy /30～33 f,the clinical target volume（CTV1） and 1（60～64） Gy/30～33f,clinical target volume 2（CTV2）（50～54） Gy/30～33 f.The prescribing dose to the primary tumor and involved nodew as 68～70Gy.The patients with stage Ⅲ and Ⅳdisease received 1 or 2 courses of combined Nedaplatin＋5-FU and Single drug Nedaplatin chemotherapy every 3 weeks from 1 to 3.According to RTOG /EORTC criteria,the acute toxicological reactions were evaluated.Results： Most of the patients had grade 1 to 2 acute toxicities,Observed grade 4 acute reaction in 1 case.With the median follow-up of 1～13 months,The 1 year estimated local regional progression survival rates,Distant metastasis survival rate and overall survival rates were 95.1%,95.1% and 100.0%,respectively.Conclusion： For the patients with early and advanced stage nasopharyngeal carcinoma,IMRT can have the well dose distribution to protect the control tissue as soon as possible,and to improve the patients＇ tolerance for toxicity,and significantly increase the clinical efficacy of treatment.Long-term effect needs further observation.