鼻咽癌常规分割与加速超分割放射治疗疗效比较

The Effect of Accelerated Hyperfractionation Versus Conventional Radiotherapy in Nasopharyngeal Carcinoma

目的 :探讨后程加速超分割能否较常规分割具有更好的鼻咽原发灶局部控制率 ,相应地提高生存率。同时观察急性和后期放射反应。方法 :15 6例经病理确诊的鼻咽鳞状细胞癌初次治疗患者 (T1 4N0 2M 0 ) ,按 92分期T1、T2、T3、T4分层 ,随机分入常规分割组 (对照组 )和后程加速超分割组 (研究组 )接受根治性放射治疗。随访中位时间 38个月 (2 2～ 6 5个月 ) ,可评价病例 15 4例。对照组 (80例 ) 180～ 193cGy/次·d-1,5d/周 ,鼻咽原发灶中位肿瘤总剂量 72 90cGy/ 39次 ,5 5d ;研究组 (74例 )放疗分两个阶段 ,第一阶段常规分割照射 ,181～ 196cGy/次·d-1,5d/周 ,剂量 40 0 0cGy/ 2 1次 ;第二阶段 15 0cGy/次 ,2次 /d ,两次照射相隔≥ 6h ,5d/周 ,每天的第二次照射用缩野技术。鼻咽原发灶中位肿瘤总剂量 735 9cGy/ 43次 ,46d。颈部根治性照射中位肿瘤总剂量 6 5 6 4cGy/ 37次 ,5 3d ,颈部预防照射中位肿瘤量 5 5 5 7cGy/ 31次 ,46d。结果 :末次随访时 ,对照组有 1例未控、8例鼻咽复发 ,研究组有 2例鼻咽复发 ,3年鼻咽局部控制率分别为 88.5 %、96 % (P =0 .0 3) ;对照组和研究组分别有 14和 13例发生远处转移 ,其中N2病例占 6 7% (18/ 2 7) ,3年生存率、无瘤生存率分别为 80 %、6 7.2 %和 88.6 %、77.9% ,而?

Purpose: A prospective randomized clinical trial was conducted to compare the effect of late course accelerated hyperfractionation(LCAHF) with that of conventional fractionation(CF) in the treatment of nasopharyngeal carcinoma(NPC).This study tried to improve the local control by treating the parients with LCAHF radiotherapy.Methods and Materials:156 patients histologically proven nasopharyngeal squamous cell carcinoma were staged,according to ′92 stage classification,to be T1-4N0-2M0 and 154 of them were randomized into CF group(n=80)or LCAHF group(n=74).The 154 patients were evaluable for analysis.The median follow-up time was 38 months(range:22～65) months).The doses of CF group to primary lesion were 6 964～7 803 cGy in 37～42 fractions with 180～190 cGy per fraction daily over 50～63 days. The radiotherapy of LCAHF was divided into two phases:About 4 000 cGy with 180～196 cGy per fraction daily,5 days weekly in the first phase,followed by 150cGy per fraction,twice daily to the total doses of 6 923～8 015 cGy in 41～47 fractions over 42～54 days.The median dose to cervical lymph nodes metastasis was 6 564 cGy in 37 fractions over 53 days.Results:At 3 months after radiotherapy,the complete response rate determined by clinical examination in CF group and LCAHF group were 98.8% and 100%,respectively while the residual mass of parapharyngeal region on CT scan was 43%(25/58)and 34%(17/50),respectively.9 cases in CF group had local failure and two cases did in LCAHF group.The 3-year free from local failure rate(FLF) was 88.5% in CF group vs 96% in LCAHF group(P=0.03).Three-year actuarial survival,disease free survival,and free from distant metastasis rates were 80%,67.22%,and 82.1%,respecrively in CF group and 88.6%,77.9%,and 76.8%,respecrively in LCAHF group,without any significant differences.Fractional regimen was demonstrated to be an independent prognostic tactor influencing local control using Cox regression model.The control rates of cervical lymph nodes were similar between these two groups.Acute toxicity was of similar magnitrde,althouhy the grade Ⅲ mucositis appeared more often in CF group.No difference in late toxicity was found between the groups.Conclusion: The late course accelerated hyperfractionation schedule can improve the local control in patients with NPC,compared with conventional fractionation.Further follow-up is needed to evaluate the effect of LCAHF scheme on long survival rate and late toxicity.