加速分割放射治疗鼻咽癌的临床研究

CLINICAL STUDY OF THE ACCELERATED FRACTIONATION RADIOTHERAPY FOR NASOPHARYNGEAL CARCINOMA

目的 :探讨加速分割放射治疗鼻咽癌的治疗效果、放射反应和并发症。方法 :研究1993年 6月— 1996年 6月经病理证实首程接受加速分割放疗的 16 8例鼻咽癌患者的局部复发率、 5年生存率、放射反应及并发症 ,并与同期接受常规分割放疗的 170例鼻咽癌患者进行对比研究。加速分割组 (研究组 )每周照射 6天 ,每天 1次 ,每次 185 c Gy～ 190 c Gy,总剂量 740 0 c Gy～ 76 0 0 c Gy/39f～ 41f,共 46天～ 48天 ,常规分割组 (对照组 )每周照射 5天 ,每天 1次 ,每次 2 0 0 c Gy,总剂量 70 0 0 c Gy～ 75 0 0 c Gy,预防剂量 5 0 0 0 c Gy～ 5 5 0 0 c Gy。结果 :随访超过 5年 ,研究组与对照组的局部复发率分别为 13.7% (2 3/16 8)和 2 6 .5 % (45 /170 ) (P<0 .0 1) ,5年生存率分别为 5 9.5 % (10 0 /16 8)和 48.8% (83/170 ) (P<0 .0 5 )。 度急性放射反应分别为 48.8% (82 /16 8)和 33.5 % (5 7/170 )(P<0 .0 1) ,并发症发生率研究组明显低于对照组。结论 :加速分割放射治疗鼻咽癌的疗效优于常规放射治疗 ,患者能耐受加速分割放射治疗方案。

Objective: To evaluate the efficacy of accelerated fractionation (AF) radiotherapy for nasopharyngeal carcinoma (NPC) . Methods: From June 1993 to June 1996 , 168 patients were histologically proven NPC , and were firstly treated with the accelerated fractionation schedule radiotherapy (6 fractions per week , one time per day , 185 cGy～190 cGy per day to a total dose of 7 400 cGy～7 600 cGy/39 f～41 f/6～7 weeks) . During the same period , 170 patients with NPC received the conventional fractionation (CF) schedule radiotherapy , clinical material distributions in both groups comparable , CF group received routine radiotherapy (200 cGy per day , 5 times a week to a total dose of 7 000 cGy～7 500 cGy/35～38FX/7～8 weeks) , neck treatment dose was 6 500 cGy～7 000 cGy , prophylactic neck treatment dose was 5 000 cGy～5 500 cGy.Results:All patients were followed up for more than 5 years,the 5 year survival rates in AF schedule group was higher than that in the CFschedule group (59.5 % versus 48.8 %,P<0.05).The local recurrent rate in AF group was lower than that in CF group (13.7 % versus 25.5 %,P<0.01) and patients in AF group had lower acute radiation reaction than those in the CF group (48.8 % versus 33.5 %,P<0.01),and complication of radiotherapy in the AF group was milder than that in the CF group.Conclusion:AF schedule for radiotherapy of NPC can give better survival rate than conventional radiotherapy.The reactions of the AF schedule can be tolerated.