鼻咽癌后程加速超分割放疗的远期疗效分析

Long-term results of late-course accelerated hyperfractionation radiotherapy for nasopharyngeal carcinoma

目的:探讨鼻咽癌后程加速超分割的远期疗效及并发症。方法:对2005年12月至2008年5月江西省赣州市肿瘤医院收治确诊为鼻咽癌的58例初治患者,随机分为后程加速超分割放疗组(研究组)和常规分割放疗组(对照组),两组开始均照射1次/天,2 Gy/次,5天/周,40～50 Gy后,研究组鼻咽部放疗2次/天,1.5 Gy/次,间隔>6 h,5天/周,总剂量73～76 Gy;对照组鼻咽部仍按常规分割放疗方法,放疗至70～76 Gy。总剂量相近,总疗程缩短0.5～1.5周。结果:研究组、对照组5年鼻咽肿瘤局控率分别为86%(25/29)、59%(17/29),差异有统计学意义(P=0.021)。研究组晚期放射损伤发生率比对照组稍增加,但差异无统计学意义。结论:后程加速超分割放疗能提高鼻咽癌的局控率,远期并发症未明显加重。

Objective： This work aims to explore the long-term efficacy and complications of late-course accelerated hyperfrac- tionation （LCAHF） for treating nasopharyngeal carcinoma. Methods： A total of 58 patients who consulted from December 2005 to May 2008 and histologically proven nasopharyngeal carcinoma at initial diagnosis were randomized into an LCAHF group （experimental group） and a conventional fractionation （CF） group （control group）. The treatment dose for both groups was 2 Gy per fraction once dai- ly, 5 days a week. After the 40 Gy to 50 Gy dose, the dosage in the LCAHF group was increased to two daily doses at 1.5 Gy per frac- tion 6 h apart, 5 days a week. The total dose in this group was 73 Gy to 76 Gy, the total dose in the CF group was 70 Gy to 76 Gy, with the total course of the treatment shortened by 0.5 weeks to 1.5 weeks in the former group. Results： The 5-year control rates of the naso- pharyngeal cancers was 86% in the LCAHF group and 59% in the CF group （P=0.021）, with statistically significant differences be- tween the two groups. The late complications slightly increased in the LCAHF group than in the CF group, but the differences were not statistically significant. Conclusion： LCAHF treatment improves the local control of nasopharyngeal carcinoma without increasing the incidence of long-term complications.