以放射敏感性为基础的T3、T4期鼻咽癌个体化颅底同期加量放射的治疗

A Study on Individualized Basilar Dose Radiotherapy of T3 and T4 Stage Nasopharyngeal Carcinoma Based on Radiosensitivity

目的结合放射敏感性探讨个体化同期加量放射治疗对T3、T4期鼻咽癌患者局控制率及放射治疗所致的毒副反应的影响。方法收集2015年5月至2017年12月收治的经病理组织学确诊为鼻咽癌的患者60例,T分期为T3或T4,对其进行放射敏感性基因CDK4、CDK6(cyclin-dependent kinases 4 and 6)的测定,两个基因均为阴性或其中一个为阴性进入研究组(个体化颅底加量组),两个基因均为阳性进入对照组(常规放疗组)。研究组鼻咽部剂量为69.96Gy,颅底剂量为75 Gy;对照组鼻咽部剂量为69.96 Gy,未进行颅底补量。结果研究组(颅底加量组)1、2 a的颅底局控率分别为96.7%、90.0%,对照组(常规放疗组)分别为93.3%、80.0%;两组之间的差异具有统计学意义(P<0.05)。研究组的中位复发时间为20个月,对照组为22.5个月,差异有统计学意义(P<0.05)。研究组与对照组的放射性脑损伤发生率分别为6.67%和3.33%,两组间的差异无统计学意义(P>0.05)。结论对于T3、T4期鼻咽癌的患者,结合其放射敏感性进行个体化颅底同期加量放射治疗,可以提高颅底局控率,且未加重放射性脑病。

Objective To explore the effect of individualized concurrent dose radiotherapy on the local control rate and toxicity of radiotherapy in patients with stage T3 and T4 nasopharyngeal carcinomain combination with radiosensitivity. Methods Sixty patients with nasopharyngeal carcinoma(NPC) diagnosed by histopathology from May 2015 to December 2017 were collected,with the T stages being T3 or T4. The radio sensitivity genes CDK4 and Cdk6(cyclin dependent kinases 4 and 6) were detected.Those with both two genes negative or one of them negative were divided into the study group(individualized skull base dosage group)and those with both two genes positive were divided into the control group(conventional radiotherapy group). The nasopharyngeal dose of the study group was 69.96 Gy, and the skull base dose was 75 Gy. The nasopharyngeal dose of the control group was69.96 Gy, and no skull base supplementation was performed.Results The local control rate of the base of skull was 96.7% and 90.0% in the study group(individualized skull base dosage group) and 93.3% and 80.0% in the control group(conventional radiotherapy group). The difference between the two groups was statistically significant(P < 0.05). Median recurrence time was 20 months in the study group and 22.5 months in the control group and there was a statistically significant difference(P < 0.05).The incidence of radioactive brain injury in the study group and the control group was 6.67% and 3.33% respectively, and the difference between the two groups was not statistically significant(P > 0.05).Conclusion For patients with stage T3 and T4 nasopharyngeal carcinoma,individualized cranial base concurrent dose radiotherapy combined with radiosensitivity can improve the local control rate of cranial base without aggravating radioactive encephalopathy.