下咽癌调强放疗的疗效分析及对喉咽功能的影响

Clinical outcome of intensity-modulated radiotherapy for hypopharyngeal carcinoma and influences on hypopharyngeal function

目的 探讨无远处转移下咽癌患者调强放疗（IMRT）的疗效,并观察IMRT后患者的喉咽功能情况.方法 回顾性分析本院2007年4月至2012年10月收治的35例无远处转移下咽癌,均采用IMRT,原发灶大体肿瘤靶区（GTV）及颈部转移淋巴结GTV2的放疗处方剂量为66 ～ 70Gy.4例行单纯放疗,31例行放化联合治疗.随访患者的复发、生存（无病生存率及总生存率）及喉咽功能情况.结果 随访5～59个月（中位16个月）,9例局部区域复发,3例远处转移.全组2年局部区域控制率、2年无病生存率和2年生存率分别为71.9％、66.1％和55.6％.13例死亡患者中有7例死于局部区域复发,3例死于远处转移.12例生存超过2年的患者中91.7％喉咽功能保留较好.结论 IMRT可提高下咽癌患者的局部区域控制率,且能较好保留喉咽功能,但局部区域复发仍是其治疗失败的主要原因.

Objective To explore clinical outcomes of intensity-modulated radiotherapy （IMRT） for hypopharyngeal carcinoma without distant metastasis,and the hypopharyngeal function after radiotherapy.Methods Thirty-five cases were retrospectively reviewed from April 2007 to October 2012.All patients received radical IMRT with or without chemotherapy.The prescribed dose for gross tumor volume （GTV） and GTV2 was 66-70Gy.Results All patients were followed up.The median follow-up time was 16 months （range 5-59 months）.Locoregional recurrence occurred in 9 catses,and distant metastasis was observed in 3 cases.The rates of 2-year locoregional control,2-year disease-free survival and 2-year overallsurvival were 71.9%,66.1% and55.6%,respectively.Seven of 13 patients died of locoregional recurrence,3 of distant metastasis.The 2-year functional laryngeal rate was 91.7%.Conclusion IMRT can improve the locoregional tumor control rate and retain the hypopharyngeal functions for patients with hypopharyngeal carcinoma.However,locoregional recurrence is the main reason for treatment failure.