鼻咽癌放射治疗失败原因分析

Patterns of treatment failure after primary radiotherapy in patients with nasopharyngeal carcinoma

目的：研究鼻咽癌放射治疗失败原因，为制定鼻咽癌治疗策略提供依据。方法： 1992年 8月至 1993年 12月， 621例鼻咽癌患者Ⅰ～Ⅳ期分别为 5.5％， 25.0％ ,47.8％及 21.7％。治疗前均行 CT或 MR检查，经鼻咽病理证实的非转移鼻咽癌接受根治性放射治疗。鼻咽腔内残留病灶，给予腔内后装治疗。随诊方法根据症状、体征、病理学及相关部位的影像学检查，生存分析用 Kaplan- Meier法 ,生存指标采用总生存、无瘤生存、无局部复发及无远处转移生存率。失败原因采用 5年累积局部、颈部复发及远处转移率。 结果： 5年总生存率、无瘤生存率分别为 61.2％、 57.3％。 T1、 T2、 T3、 T4的 5年局部复发率分别为 7.6％、 12.9％、 24.1％及 41.3％ ;N0、 N1、 N2、 N3的颈部复发率分别为 2.3％、 7.5％、 12.0％及 43.6％； N0、 N1、 N2、 N3的 5年远处转移率分别依次为 6.9％、 19.5％、 31.3％及 53.7％。 75.7％的远处转移为单纯转移。治疗失败的患者中 14.4％合并局部、颈部复发及远处转移中的两项或两项以上。结论：远处转移仍为鼻咽癌治疗失败主要原因， T分期的严重程度与局控率密切相关。就放射治疗而言，精确的治疗计划可望提高鼻咽癌的生存率。

Objective： The current study was designed to analyze causes of treatment failure after primary radiotherapy in patients with nasopharyngeal carcinoma (NPC). Methods： Between August 1992 and December 1993,621 patients with histologically proven NPC were treated by definitive radiotherapy. According to the Chinese 1992 staging system, there were 34 (5.5％ ), 155 (25.0％ ), 300 (47.8％ ), and 132 (21.7％ ) patients in stageⅠ ,Ⅱ ,Ⅲ , and IV, respectively. All patients had CT or MR scan of the nasopharynx and the skull base during the staging work- up. Follow- up evaluation included complete physical examination,histological, and imaging methods. The Kaplan- Meier method was used in calculation of survival. The cumulative local failure, regional failure, and distant metastasis rates were used for evaluation of treatment failure. Results： The 5- year overall and relapse free survival rates were 61.2％ and 57.3％ , respectively. The cumulative local failure rates for patients with T1, T2, T3, and T4 disease were 7.6％ , 12.9％ , 24.1％ , and 41.3％ , respectively. The cumulative regional failure rates for patients with N0, N1, N2, and N3 disease were 2.3％ , 7.5％ , 12.0％ , and 43.6％ , respectively. The cumulative distant failure rates for patients with N0, N1, N2, and N3 disease were 6.9％ , 19.5％ , 31.3％ , and 53.7％ , respectively. 75.7％ of distant metastases were not associated with local or regional recurrence. Multi- site failure was in 14.4％ of failed patients. Conclusion： Distant metastasis is the most common cause of failure in NPC treatment. The T- classification is significantly correlated with local failure. Advances in radiation methods may improve local control, and hence survival.