初治鼻咽癌调强适形放疗178例临床疗效观察

Clinical Observation of 178 Nasopharyngeal Carcinoma Patients for Intensity Modulated Radiotherapy

目的分析调强适形放疗(IMRT)治疗初治鼻咽癌(NPC)的临床疗效、治疗失败因素和急性血液系统毒副反应。方法回顾性分析179例按2008广州分期为Ⅰ~Ⅳ期鼻咽癌患者。所有患者均接受全程根治性调强适形放疗,68例行单纯放疗,111例行放化疗综合治疗。结果中位随访时间为54.9(2.7~133.9)个月,5年局部无复发生存率(LRFS)、总生存率(OS)、无远处转移生存率(DMFS)、无进展生存率(PFS)分别为91.8%,63.7%,72.0%,65.1%.全组54例(30.2%)出现远处转移和(或)局部区域复发。远处转移最常见(41例,75.9%),其次是鼻咽局部区域复发(13例,24.1%)。T1,T2,T3,T4期患者7年LRFR分别为100.0%,97.4%,67.1%,66.0%,χ~2=8.06,P=0.045;Ⅰ~Ⅱ,Ⅲ,Ⅳ期患者7年PFS分别为80.8%,64.0%,47.7%,53.6%,χ~2=10.72,P=0.01。含同期化疗及不含同期化疗与单纯放疗相比,可明显改善总生存(P=0.04,0.03)。急性血液毒性反应局限于0~2级。结论鼻咽癌IMRT联合化疗较单纯放疗总生存明显获益,且局部控制较佳,不良反应可耐受,远处转移是失败的主要模式,需探索更加有效的综合治疗方案。

Objective To analyse clinical efficacy of intensity modulated radiation therapy（IMRT） for primitive nasopharyngeal carcinoma（NPC）.Methods Totally 179 non-metastatic NPC patients with stage Ⅰ～ Ⅳ underwent IMRT were analyzed retrospectively.And68 patients received radiotherapy alone and 111 received chemoradiotherapy.Results With a median follow-up of 54.9 months（range,2.7 ～131.6 months）.The 7-year LRFS,OS,DMFS,and PFS were 87.2%,58.6%,69.6%,and 59.4%,respectively.Of 179 patients,54（30.2%） developed failure after treatment.Of the 54 patients,41（75.9%）,13（24.1%） had developed distant metastasis,primary and regional nodal recurrence,respectively.Distant metastasis was the major failure pattern after treatment.The 7-year LRFS in patients with T1,T2,T3,and T4 were 100.0%,97.4%,67.1%,and 66.0%,respectively（χ^2=8.06,P=0.045）.The 7-year PFS in patients with Ⅰ～Ⅱ,Ⅲ,Ⅳwere 80.8%,64.0%,47.7%,respectively（χ^2=10.72,P=0.01）.The OS of containing concurrent chemoradiotherapy or non-concurrent chemoradiotherapy was significantly higher than that of IMRT alone（P=0.04,0.03 respectively）.The most common acute hematologic toxicity was limited to grade 0～2.Conclusion IMRT combined with chemotherapy for NPC yielded satisfactory overall survival compared with IMRT alone.The treatment-related toxicities are acceptable.Distant metastasis is the most common failure pattern after treatment.We need to explore effective comprehensive treatment program.