复发鼻咽癌大分割与常规分割三维适形放疗对比分析

Comparative analysis of three-dimension conformal radiotherapy for large segmentation and conventional segmentation of recurrent nasopharyngeal carcinoma

目的复发鼻咽癌再程放疗困难重重,再程放疗后晚期放射损伤发生率高,且5年生存率低。本研究对比分析大分割与常规分割三维适形放疗治疗鼻咽复发鼻咽癌的放射损伤反应、生活质量影响及疗效。方法回顾性分析中国人民解放军联勤保障部队第九二一医院肿瘤科2008-11-06-2012-10-25收治的复发鼻咽癌患者117例,按治疗情况分成鼻咽癌复发常规分割适形放疗组(对照组59例)和鼻咽癌复发大分割适形放疗组(研究组58例),对照组为常规分割,5次/周,2Gy/次,共30～35次,总量60～70Gy/6～7周。研究组为大分割,5次/周,3Gy/次,共17～20次,总量51～60Gy/4周,观察放射损伤反应、生活质量影响、近期疗效、远期疗效等。结果两组患者近期放射损伤反应如口干(χ~2=1.029,P=0.310)、颌面部皮肤反应(χ~2=1.239,P=0.266)、乏力(χ~2=0.210,P=0.646)发生率差异均无统计学意义。研究组口腔黏膜反应(46.6%)明显比对照组(25.4%)高,χ~2=5.674;P=0.017;两组患者远期放射损伤如口干(χ~2=0.364,P=0.546)、颌面部肌肉纤维化(χ~2=0.010,P=0.919)、放射性脑病(χ~2=1.143,P=0.285)发生率差异均无统计学意义。研究组耳聋(χ~2=4.414,P=0.043)、张口困难(χ~2=4.499,P=0.034)明显比对照组高;两组鼻咽癌患者生活质量评价(KPS评分、体质量变化)治疗前与治疗结束时、治疗结束时与治疗后3个月对比,均P>0.05;3个月后局部控制率(tumor control probability,TCP)对照组为54.2%(32/59),研究组为69.0%(40/58),差异无统计学意义,χ~2=2.681,P=0.102;6个月后对照组TCP为62.7%(37/59),研究组为79.3%(46/58),差异有统计学意义,χ~2=3.909,P=0.048;9个月后对照组TCP为67.8%(40/59),研究组为84.5%(49/58),差异有统计学意义,χ~2=4.473,P=0.034;12个月后对照组TCP为69.5%(41/59),研究组为87.9%(51/58),差异有统计学意义,χ~2=5.919,P=0.015。对照组1年生存率(overallsurvival,OS)为94.9%(56/59),研究组为96.6%(56/58),差异无统计学意义,χ~2=1.191,P=0.662;2年对照组OS为71.2%(42/59),研究组为81.0%(47/58),差异无统计学意义,χ~2=1.558,P=0.212;3年对照组OS为50.8%(30/59),研究组为69.0%(40/58),差异有统计学意义,χ~2=3.995,P=0.046;4年对照组OS为39.0%(23/59),研究组为58.6%(34/58),差异有统计学意义,χ~2=4.515,P=0.034;5年对照组OS为32.2%(19/59),研究组为51.7%(30/58),差异有统计学意义,χ~2=4.579,P=0.032。结论复发鼻咽癌治疗中,大分割三维适形放疗比常规分割放疗疗程有明显缩短,从而降低了部分放射损伤反应,对生活质量影响较小,能明显提高肿瘤的TCP,近期疗效和远期疗效较好。

OBJECTIVE Recurrent nasopharyngeal carcinoma is difficult to undergo radiotherapy, the incidence of late radiation injury after re-radiation is high,and the 5-year survival rate is low.This study compared the effects of large segmentation and conventional segmentation of three-dimensional conformal radiotherapy on radiation injury response quality of life and efficacy of nasopharyngeal recurrent nasopharyngeal carcinoma.METHODS A retrospective analysis of 117 cases of recurrent nasopharyngeal carcinoma patients admitted to the Department of Oncology,The No.921 Hospital of PLA Joint Logistics Support Force, 2008-11-06-2012-10-25, according to the treatment situation, resection of nasopharyngeal carcinoma recurrent conventional conformal radiotherapy Group (control group) and nasopharyngeal carcinoma recurrence large-segment conformal radiotherapy group (study group), control group was routinely divided, 5 times/week.2 Gy/time,a total of 30-35 times,the total amount of 60 - 70 Gy/6 - 7 weeks.The study group consisted of large segmentation, times/week,3 Gy/time,a total of 17 to 20 times,the total amount of 51-60 Gy/4 weeks,observed radiation damage response,quality of life effects, short-term efficacy, long-term efficacy.RESULTS The incidence of recent radiation injury in the two groups was as follows:dry mouth (X^2=1.029,P=0.310),maxillofacial skin reaction (X^2=1.239, P=0.266),and fatigue (X^2=0.210,P=0.646).The oral mucosal response of the study group (46.6%) was significantly higher than that of the control group (25.4%,X^2=5.674;P=0.017);the long-term radiation damage of the two groups was dry mouth (X^2=0.364,P=0.546),maxillofacial muscle fibrosis (X^2=0.010,P=0.919) and radiation encephalopathy (X^2=1.143 ,P=0.285).The study group had deafness (X^2=4.414 ,P=0.043) and difficulty in opening mouth (X^2=4.499,P=0.034), which was significantly higher than that of the control group.After 3 months, the local control rate (TCP) was 54.2%(32/59),and the study group was 69.0%(40/58),the difference was not statistically significant (X^2=2.681,P=0.102);TCP was 62.7%(37/59) after 6 months in the control group,and 79.3%(46/58) in the study group (X^2=3.909 ,P=0.048);TCP was 67.8%(40/59) after 9 months in the control group and 84.5%(49/58) in the study group(X^2=4.473,P=0.034);TCP was 69.5%(41/59) after 12 months in the control group and 87.9%(51/58) in the study group(X^2=5.919.P=0.015).The 1-year OS rate of the control group was 94.9%(56/59),and that of the study group was 96.6%(56/58).the difference was not statistically significant(X^2=1.191, P=0.662);the 2-year OS rate of the control group was 71.2%(42/59), that of the study group was 81.0%(47/58),and the difference was not statistically significant(X^2=1.558,P=0.212);the 3-year OS rate of the control group was 50.8%(30/59), that of the study group was 69.0%(40/58),the difference was statistically significant(X^2=3.995 ,P=0.046);the 4-year OS rate of the control group 39.0%(23/59), that of the study group was 58.6%(34/58), and the difference was statistically significant(X^2=4.515 ,P=0.034);the 5-year OS rate of the control group was 32.2%( 19/59), that of the study group was 51.7%(30/58),the difference was statistically significant(X^2=4.579,P=0.032).CONCLUSIONS In the treatment of nasopharyngeal recurrent nasopharyngeal carcinoma, the large-segment three-dimensional conformal radiotherapy is significantly shorter than the conventional segmentation radiotherapy.Thereby reducing part of the radiation damage response .the impact on the quality of life is small,can significantly improve the tumor TCP, the short-term efficacy and long-term efficacy is better.