鼻咽癌超腔、颅底骨破坏和颅神经损害者放疗疗效分析

Analysis of radiotherapeutic effects of the extra - cavitary nasopharyngeal carcinoma with skull base and cra- nial nerves damage

目的:分析鼻咽癌超腔、颅底骨破坏和颅神经损害而无颈淋巴结转移的患者放疗效果.方法:1980年9月～1988年9月收治的鼻咽癌原发灶超腔、颅底骨破坏和颅神经损害的患者205例.鼻咽病灶全部用^(60)Co放射,有38例单用耳前野放射,其余以耳前野为主,眶下野、鼻前野为辅野.有颅底骨破坏、前组颅神经损害者加照颅底野,有后组颅神经损害者加照患侧耳后野,肿瘤量60～80GY/W.颈部预防照射^(60)Co切线野40GY加深部X线20GY.结果:总的5年生存率为47.3%,原发灶超腔者、颅底骨破坏者、颅神经损害者和侵犯两项以上者的5年生存率分别是61.7%、72.7%、37.1%和30.2%.鼻咽剂量60Gy、70Gy、80Gy的5年生存率各是32.0%、53.8%、38.0%,P<0.05.体重增加者5年生存率为62.7%;下降者为32.2%.结论:以伴颅底骨质破坏和原发性超腔的鼻咽癌患者放疗效果较好.放射剂量以DT70Gy/7周为宜,营养支持使体重增加有助于提高疗效.

Objective:To analysis retrospectly 205 patients with extra ?cavitary NPC with skull base and cranial nerves dam-ages. Methods:205 patiens with extra?cavitary NPC with skull base and cranial nerves damage were treated by radiotherapy from 1980 to 1988. Of these, 38cases were irrated alone by bilateral auricular fields. Rest received supplement pre ?nasal field or infraor-bital field; basal cranial fields were supplemented when skull base and front ~ group cranial nerves damage. Post ?auricular field were supplement as posterior ?group cranial nerves damage. The tumor dose were 60~80GY/6~8 weeks. All patients received 60 Co ?r ray combined with deep X-ray irradiation in neck. Results: The overall 5 years survival (auarial method) were 47.3% . The 5 years survival rate of patient with invasion of skull base, extra - cavitary and cranial nerves damage were 72.7%, 61.7%, 37.1% respectively(P<0.05) . The 5 years survival rates were 32.0%, 53.8% and 38.0% separately in nasopharyngeal radiation dosage of 60GY, 70GY and 80GY (P<0.05) . Conclusion:The optimum radiation dose is 70GY/7 weeks. The skull damage of NPC with-out cervial node matastasis has better effects and ligher survival rate. Nutritional support for increasing body weight improves effects of the treatment.