鼻咽癌咽旁侵犯患者的远期疗效分析

Prognostic Influence of Parapharyngeal Space Involvement in Nasopharyngeal Carcinoma

目的 通过对鼻咽癌咽旁侵犯患者的远期疗效的分析 ,为合理的设野和临床分期提供依据。方法 对 1984年 10月至 1989年 9月收治的经病理、CT检查诊断有咽旁侵犯的 12 0例鼻咽癌患者 ,采用常规分段放射治疗。鼻咽原发灶设两耳前野为主 ,部分辅以鼻前野。鼻咽肿瘤总剂量为 68～ 78Gy ,照射 3 4～ 3 9次 / 72～ 85天。颈部根治性肿瘤总剂量为 60～ 68Gy ,照射 3 0～3 4次 / 72～ 76天 ;预防剂量为 5 0Gy。全部病例 5年随访率为 10 0 .0 % ,10年随访率为 95 .0 %。 结果 茎突前区和茎突后区受侵犯者 5年生存率分别为 66.1%和 44 .8% ,10年生存率分别为 3 7.1%和 2 5 .9% ;颈部淋巴结Ⅱ、Ⅲ期 10年生存率分别为 3 5 .6%和2 8.0 % ;2年内鼻咽复发率分别为 19.4%和 44 .8%。茎突前区咽旁侵犯同时伴有颅底骨质破坏、颅神经损害和口咽侵犯的发生率分别为 6.5 %、6.5 %和 11.3 % ,而茎突后区分别为 19.0 %、2 5 .9%和 3 6.2 %。结论 咽旁侵犯是影响鼻咽癌预后的重要因素 ,然而 。

Objective To assess the prognostic influence of parapharyngeal involvement in nasopharyngeal carcinoma(NPC).Methods From 1984 to 1989,120 cases of NPC with parapharyngeal space involvement were confirmed by pathology and by CT scanning.The primary nasopharyngeal lesions were all irradiated in two preauricular fields routinely and some of them in prenasal field.The total dose of irradiation for the primary tumor and for tumor after neck radical treatment were 68～78 Gy(34～39 fractions/72～85 days) and 60～68 Gy(30～34 fractions/72～76 days).The prophylactic dose of irradiation in both necks was 50 Gy.The follow-up rates of 5 years and 10 years were 100% and 95% respectively.Results The 5-year and 10-year survival rates with pre-styloid and retro-styloid compartment involvement were 66.1% and 37.1%,44.8% and 25.9% respectively.The 10-year survival rate for patients with stage Ⅱ and Ⅲ cervical nodes involvement were 35.6% and 28.0%.Local recurrence within two years were 19.4% and 44.8% respectively.The rates of skull base infiltration,cranial nerves involvement palsy,and oropharyngeal involvement in tumors with pre-styloid and retro-styloid compartment involvement were 6.5%,6.5% and 11.3%,19.0%,25.9% and 36.2% respectively.Conclusion The parapharyngeal space involvement is a significant prognostic factor in NPC.Of course,the previous technique may have a potential influence on treatment outcome.