立体定向放射治疗和三维适形放射治疗对局部复发鼻咽癌的效果比较

Comparison the curative effect of stereotactic body radiation therapy and three-dimensional conformal radiation therapy for locally recurrent nasopharyngeal carcinomas

目的比较立体定向放射治疗(stereotactic body radiation therapy,SBRT)和三维适形放射治疗(three-dimensional conformal radiation therapy,3D-CRT)对局部复发鼻咽癌的效果。方法回顾性分析本院2008年1月至2011年1月收治的77例局部复发鼻咽癌患者,按照治疗方式分为SBRT组(n=36)和3D-CRT组(n=41),分别接受SBRT和3D-CRT治疗,比较两组患者近期疗效,远期疗效和晚期不良反应发生情况。结果 SBRT组患者完全缓解(CR)明显高于3D-CRT组,部分缓解(PR)低于3D-CRT组(P<0.05),两组患者稳定(SD)比较差异无显著性(P>0.05)。两组患者随访前2年局部控制率比较差异无显著性(P>0.05),SBRT组患者3年局部控制率明显高于3D-CRT组(P<0.05)。两组患者随访前2年的生存率比较差异无显著性(P>0.05)。SBRT组3年生存率明显高于3D-CRT组(P<0.05)。3D-CRT组患者并发症发生率明显高于SBRT组,其中两组患者张口困难和脑损伤发生率比较差异具有显著性(P<0.05),颅神经病变和颈动脉破裂综合征比较差异无显著性(P>0.05)。结论 SBRT较3D-CRT更能够提高局部复发鼻咽癌近期疗效和3年局部控制率,延长患者3年生存率,减少晚期不良反应,是一种更安全有效的治疗方式。

Objective To compare the curative effect of stereotactic body radiation therapy（SBRT） and threedimensional conformal radiation therapy（3D-CRT） for locally recurrent nasopharyngeal carcinomas. Method Retrospective analysed of our hospital from January 2008 to January 2011 77 cases of locally recurrent nasopharyngeal carcinoma, according to the therapy method, they were divided into SBRT group（n = 36） and 3D-CRT group（n = 41）. The short-term curative effect, long-term curative effet and late adverse reactions between the two groups were compared. Result The complete response（CR） in SBRT group was higher than 3D-CRT group（P〈0.05）, and the partial remission（PR） in SBRT group was lesser than 3D-CRT group（P〈0.05）. There was no significant difference between the two groups in stabilization（SD）（P〈0.05）. The twoyears actuarial local control rate between the two groups had no significant difference（P〉0.05）. The three-years actuarial local control rate in SBRT group was higher than 3D-CRT group（P〉0.05）. The two-years survival rate had no significant difference between the two groups（P〈0.05）. The three-years survival rate in SBRT group was higher than 3D-CRT group（P〈0.05）. The complications in 3D-CRT group were higher than SBRT group（P〈0.05）. There were significant differences between the two groups in complications included trismus and brain necrosis（P〈0.05）, cranial neuropathy and carotid blow-out syndrome had no significant difference between the two groups（P〉0.05）. Conclusion SBRT could improve early curative effect and three-years actuarial local control rate, prolong three-years survival rate and reduce late complications compared with 3D-CRT. SBRT is a more safe and effective treatment method.