局部复发鼻咽癌再程调强放疗的临床疗效和预后研究

Clinical Efficacy and Prognostic Factors of Locally Recurrent Nasopharyngeal Carcinoma with Intensity-modulated Radiotherapy

【目的】研究鼻咽癌治疗后局部复发患者再次行调强放疗的疗效及影响预后的相关因素。【方法】回顾性研究分析本院收治的132例鼻咽癌综合治疗后局部复发患者的临床资料。其中，男性93侧，女性39例，中位年龄49．8（25～72）岁，初治后复发时间间隔平均为55（11～201）个月。确诊复发后，所有患者均采用三维调强适形放疗进行治疗。【结果】132例患者中12例失访，中位随访时间为34．6个月，中位生存时间36．3个月，1、3、5年生存率分别为79％（95／120）、55％（66／120）、25％（30／120）。至随访截止日期，死亡55例，其中29例因放疗副作用死亡，14例因放疗后再复发，11例因远处转移，1例放疗后再复发并转移。单因素分析结果显示，性别、年龄、既往吸烟史、初治肿瘤原发灶（Tumor，T）分期、初治淋巴结（Node，N）分期、初治临床分期、复发T分期、复发N分期、复发临床分期、原发肿瘤体积（Gross Tumor Volume，GTV）剂量、临床靶区体积（Clinieal Target Volume，cTV）剂量、GTV体积、CTV体积、合并化疗与否、治疗后疗效评价、使用放疗增敏剂等因素均与生存期无明显相关（P〉0．05）；多因素分析提示，初治临床分期及复发T分期是预测无远处转移的复发鼻咽癌的独立预后因素（P〈0．05）。近期毒副反应主要包括骨髓抑制、胃肠道反应、放射性口腔黏膜炎，无一例发生4级毒副反应。【结论】鼻咽癌治疗后局部复发再程调强放疗有效、可靠，毒副反应可耐受；初治临床分期及复发T分期是预测无远处转移的复发鼻咽癌的独立预后因素。

[Objective]To study the clinical efficacy and prognostic factors of locally recurrent nasopharyngeal carcinoma with intensity-modulated radiotherapy.[Methods] A retrospective study of 132 patients with locally recurrent nasopharyngeal carcinoma, 93 male and 39 female with the median age 49.8 （25-72） years old and the average time interval after the first treatment 55 （11 - 102）months. All the patients who were identified recurrence were accepted into intensity-modulated radiotherapy.[Results]Excluding the 12 patients who were not followed up, the median follow-up time was 34.6 months and median survival time was 36.3 months. Overall survival rate of 1,3,and 5 years were79% ,55%,25% ,respectively. At the end of follow-up time, there were 55 dead cases, 29 of which were caused by long-term side effects, 14 of which were caused by second-time recurrences, 11 of which were caused by distant metastasis and 1 of which was caused by distant metastasis accompanied by second-time recurrence. The univariate analysis showed that the factors sex, age, smoking history, primary tumor （T） stage, primary lymph node （N） stage, primary clinical stage, recurrent T stage , recurrent N stage, recurrent clinical stage, Gross Tumor Volume（GTV）, Clinical Target Volume（CTV）, the volume of GTV, the volume of CTV, the presence of chemotherapy complication, therapeutic evaluation, and the use of radiation sensitizer, were not positively related to the survival time （ P 〉0.05）. The multivariate analysis showed that the primary clinical stage and the recurrent T stage influenced the prognosis of locally recurrent nasopharyngcal carcinoma after radiotherapy （ P〈0.05） . To study the toxicity response, it contained bone marrow suppression, gastrointestinal reaction, and radioactive mucositis. 4 degree toxicity response did not occur in any patients.[Conclusion]Intensity-modulated radiotherapy for locally recurrent nasopharyngeal carcinoma is reliable and effective. Toxicity response is tolerable. The primary clinical stage and the recurrent T stage influencs the prognosis of locally recurrent nasopharyngeal carcinoma after radiotherapy.