调强放疗治疗初治鼻咽癌的近期疗效分析

Analysis of Short-term Curative Effect of Intensity-modulated Radiotherapy for 62 Nasopharyngeal Carcinoma

目的:探讨调强适形放射治疗(intensity modulated radiation therapy,IMRT)在初治鼻咽癌中的近期临床疗效及不良反应。方法:对62例初治鼻咽癌患者行IMRT,Ⅲ、Ⅳ期患者行顺铂同步化疗,采用Kaplan-meier法进行生存分析,Log-rank检验组间差异,用Cox逐步回归模型分析鼻咽癌患者的预后相关因素。结果:1、2年总生存率分别为95.16%、93.55%; 1、2年局部/区域控制率分别为98.39%、95.16%;无远处转移生存率分别为91.94%、88. 71%;不良反应主要为放射性皮肤损伤、放射性黏膜炎、唾液腺放射性损伤及骨髓抑制,1例患者出现骨髓抑制4级,其余急性放射损伤反应均为1～3级。多因素分析表明临床分期及化疗是影响鼻咽癌生存率的独立预后因素。结论:IMRT治疗鼻咽癌局部控制佳、不良反应轻,近期临床疗效好。

Objective To investigate the short-term clinical efficacy and adverse reactions of intensity-modulated radiotherapy( IMRT) in nasopharyngeal carcinoma. Methods Sixty-two patients with nasopharyngeal carcinoma were treated with IMRT or cisplatin-based chemotherapy in stages III and IV. Survival analysis was performed using Kaplan-meier method.Log-rank test was used to examine the differences between groups. Cox stepwise regression model was used to analyze the prognostic factors of patients with nasopharyngeal carcinoma. Results The 1-year and 2-year overall survival rates were 95.16% and 93.55%; the 1-or 2-year local/regional control rates were 98.39% and 95.16%; and the distant metastasis free survival rates were 91.94%,88.71%,respectively. Adverse reactions were mainly radiation skin damage,radiation mucositis,salivary gland radiation damage and bone marrow suppression. One patient had bone marrow depression of grade 4,and the other acute radiation injury reactions were all grade 1 ~ 3. Multivariate analysis showed that clinical stage and chemotherapy were independent prognostic factors affecting survival rate of nasopharyngeal carcinoma. Conclusion IMRT treatment of nasopharyngeal carcinoma has good local control,mild adverse reactions and good short-term clinical efficacy.