N0期鼻咽癌颈部可疑阳性淋巴结放疗剂量的探讨

Research of Radiotherapy Dose on Suspicious Positive Lymph Nodes in Neck Negative Nasopharygneal Carcinoma Patients

目的观察N0期鼻咽癌患者颈部可疑阳性淋巴结(最大横断面短径≥0.5 cm但<1 cm、包膜完整、无中央坏死)放疗剂量为64Gy时淋巴结的消退情况、有无局部复发,以及患者的不良反应及预后。方法回顾性分析2008年1月—2011年1月我院80例有颈部可疑阳性淋巴结的N0期鼻咽癌患者,按中国鼻咽癌2008年分期标准,T1期4例,T2期15例,T3期36例,T4期25例。所有患者均采用调强放疗,其中T1、T2患者采用单纯放疗,T3、T4患者配合单药铂类方案同步化疗。鼻咽大体肿瘤体积(GTVnx)处方剂量70～74 Gy,颈部未达标可疑阳性淋巴结(GTVnd可疑阳性)处方剂量64 Gy,临床靶体积1(CTV1)处方剂量60～64 Gy,临床靶体积2(CTV2)处方剂量50～54 Gy,分30次进行照射,照射时间6周。采用配对t检验比较放疗前后淋巴结的消退有无统计学意义。结果随访率为98.8%。80例患者129个淋巴结,放疗后颈部可疑阳性淋巴结CR117个,PR6个,NC6个,有效率95.3%。放疗前后淋巴结消退有意义(P<0.05)。4年局部控制率、无远处转移率、总生存率分别为94.6%、95.9%、93.7%。有4例GTVnx内复发,3例出现远处转移。颈部放射性皮肤反应1、2级分别占77.5%、22.5%。颈部纤维化1级占15%。结论64Gy的放疗剂量是鼻咽癌颈部可疑阳性淋巴结转移很好的控制剂量,且不良反应较轻,患者可耐受。

Objective To investigate the regression of lymph nodes, local recurrence, adverse effects and prognosis in neck negative nasopharygneal carcinoma（NPC） patients with uspicious positive lymph nodes （0. 5 cmmaximum diameterl cm, intact capsule, no central necrosis） treated by 64Gy radiation doses. Methods From Jan 2008 to Jan 2011,80 NPC patients with NO stage who had suspicious positive lymph nodes were studied retrospectively. According to the 2008 staging system, there were 4 patients in stage T1,15 in stage T2,36 in stage T3 and 25 patients in stage T4. All patients were irradiated by IMRT technique. Patients in T1 and T2 were treated by IMRT alone while patients in T3 and T4 by concurrent chemotherapy. The prescription does was （70-74）Gy/30f to the nasopharynx gross tumor volume （GTVnx） ,64Gy/30f to suspicious positive neck lymph nodes （GTVndsuspicious positive）, （60-64）Gy/ 30f to the first clinical target volume（CTV1） and （50-54）Gy/30f to the second clinical target volume （CTV2）. The irradiation time was 6 weeks. Paired T test was used to compare the regression of lymph nodes before and after radiation. Results The follow-up rate was 98. 8%. 80 patients had 129 lymph nodes. 117 lymph nodes was CR,6 was PR and NC was 6. Partial response rate was 95. 3o//oo. The regres- sion of lymph nodes had statistical differences （P〈0. 05） between before and after radiation. The 4-year local-regional control rates, distant metastasis-free survival rate and overall survival rate were 94. 6%, 95. 9% and 93. 7%. 4 patients had recurrent events in GTVnx and 3 patients had distant metastasis. The neck skin reaction with grade 1 and 2 was 77. 5% and 22. 5% respectively. Neck skin radiation fibrosis with grade 1 was 15%. Conclusion The 64Gy radiation dose was the appropriate control dose on suspicious positive lymph nodes in neck negative nasopharygneal carcinoma patients with a acceptable adverse effect.