摘要
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.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2000年第11期1016-1018,共3页
Chinese Journal of Cancer
关键词
鼻咽肿瘤
放射治疗
治疗失败
远处转移
复发
Nasopharyngeal neoplasms
Radiotherapy
Local recurrence
Regional recurrence
Distant metastasis