调强放射治疗联合化疗治疗复发性鼻咽癌的临床分析

Clinical analysis of recurrent nasopharyngeal carcinoma IMRT radiotherapy combined with chemotherapy

目的探讨调强放疗(IMRT)联合化疗治疗复发性鼻咽癌的临床疗效和相关预后因素。方法按照美国癌症联合委员会(AJCC)标准再分期的37例T_2~T_4复发性鼻咽癌进入临床分析,其中男性29例,女性8例;中位年龄48岁,中位复发时间为24个月。T_2期17例、T_3期11期、T_4期9例。37例患者中,9例合并颈部淋巴结复发。再程IMRT单次中位剂量为2.24Gy,大体肿瘤体积(GTV)剂量为60~70Gy。所有患者放疗中均联合应用顺铂80mg/m^2同步单药化疗2~3个周期,其中26例(Ⅲ、Ⅳa期)患者采用新辅助化疗2个周期(PF/DP/GP方案),第2个周期化疗结束后5 d内开始IMRT。予以观察临床疗效并进行预后因素分析。结果 26例患者接受新辅助化疗2个周期后予以疗效评价,其中部分缓解(PR)19例(73.1%),疾病稳定(SD)7例(26.1%)。所有患者治疗结束后进行疗效评价,其中完全缓解(CR)16例(43.2%),PR 21例(56.8%)。治疗结束后3个月疗效评价,CR例25例(67.6%),PR9例(24.3%);1、2、3年总生存率分别为73.0%、51.4%和43.2%。中位GTV 40.1 cm^3,GTV是影响复发鼻咽癌预后的主要因素。结论 IMRT联合化疗治疗复发性鼻咽癌的临床疗效显著,GTV是影响复发鼻咽癌预后的主要因素。

Objective The aim of the study is to assess the effectiveness and factors associated with prognosis of intensity-modulated radiotherapy（ IMRT） and concurrent chemotherapy for recurrent nasopharynx carcinoma. Methods A total of 37 local recurrent NPC patients were analyzed. All patients underwent disease re-staging using the AJCC staging system（ T_2-T_4） with 29 males and 8 females among the group with median age which was 48 years（ 24-75 years）. The number of cases with re-staging T-stage T_2,T_3,T_4 were 17,11,9 respectively and 9 patients combined with relapse neck lymph nodes. The median bolus dose was 2. 24Gy（ 2. 0-2. 33Gy） and the prescribed dose of GTV was 60-70 Gy. All patients were treated with concurrent chemotherapy by using DDP 80 mg/m^22-3 cycles alone during the radiotherapy treatment,26 patients with re-staging III,IVa underwent neoadjuvant chemotherapy（ PF/DP/GP regimens） 2cycles ahead and received IMRT within 5 days after chemotherapy. Results The clinical effectiveness of 26 patients who were received neoadjuvant chemotherapy before radiotherapy were as follows： 19 cases PR（ 73. 1%）,7 cases SD（ 26. 1%）. Of the 37 cases,the effectiveness of CR were 11 cases（ 29. 7%） and PR were 26 cases（ 70. 3%） right after the whole treatment. The effectiveness of CR were 25 cases（ 67. 6%）and PR were 9 cases（ 24. 3%） 3 months later. The overall survival rates（ OS） of 1-year,2-year and 3-years were 73. 0%,51. 4% and 43. 2% respectively. The median volume of GTV was 40. 1 cm^3 and the volume of GTV was the main prognostic factor of recurrent nasopharynx carcinoma according to univariate analysis.Conclusions IMRT clinical efficacy of radiotherapy combined with chemotherapy in the treatment of recurrent nasopharyngeal carcinoma significantly,GTV volume is a major factor affecting the prognosis of recurrent nasopharyngeal carcinoma.