Signal intensity changes of dentate nucleus on plain MR T1WI innasopharyngeal carcinoma patients after radiotherapy andmultiple injections of gadolinium-base contrast agent

Objective To observe changes of plain MR T1WI signal intensity of dentate nucleus in nasopharyngeal carcinoma patients after radiotherapy and multiple times of intravenous injection of gadolinium-based contrast agent(GBCA).Methods Fifty patients with pathologically confirmed nasopharyngeal carcinoma and received intensity-modulated radiotherapy were retrospectively enrolled as the nasopharyngeal carcinoma group,and 50 patients with other malignant tumors and without history of brain radiotherapy were retrospectively enrolled as the control group.All patients received yearly GBCA enhanced MR examinations for the nasopharynx or the head.T1WI signal intensities of the dentate nucleus and the pons on same plane were measured based on images in the year of confirmed diagnosis(recorded as the first year)and in the second to the fifth years.T1WI signal intensity ratio of year i(ranging from 1 to 5)was calculated with values of dentate nucleus divided by values of the pons(ΔSI i),while the percentage of relative changes of year j(ranging from 2 to 5)was calculated withΔSI j compared toΔSI 1(Rchange j).The values of these two parameters were compared,and the correlation ofΔSI and GBCA injection year-time was evaluated within each group.Results No significant difference of gender,age norΔSI 1 was found between groups(all P>0.05).The second to the fifth yearΔSI and Rchange in nasopharyngeal carcinoma group were all higher than those in control group(all P<0.05).Within both groups,ΔSI was positively correlated with GBCA injection year-time(both P<0.05).Conclusion Patients with nasopharyngeal carcinoma who underwent radiotherapy and multiple times of intravenous injection of GBCA tended to be found with gradually worsening GBCA deposition in dentate nucleus,for which radiotherapy might be a risk factor.

THREE-DIMENSIONAL CONFORMAL RADIATION THERAPY FOR LOCALLY RECURRENT NASOPHARYNGEAL CARCINOMA

Objective: To investigate the safety and effectiveness of three-dimensional conformal radiation therapy (3-D CRT) for locally recurrent nasopharyngeal carcinoma (NPC). Methods: From April 1998 to March 2000, 34 patients who had undergone previous external beam radiation therapy were retreated with 3-D CRT for locally recurrent NPC (33 poorly differentiated squamous cell carcinomas, 1 adenoma). The patients were re-staged according to Huaqing staging system with the following distribution: T1N0M0 in 5 cases, T2N0M0 in 11 cases, T3N0M0 in 12 cases, T4N0M0 in 6 cases. The maximal dimension of the gross tumor volume (GTV) ranged from 1.0 cm to 5.0 cm (median: 2.9 cm). CT simulation and 3-D planning were used to ensure full and conformal coverage of the planning target volume (PTV) by treated volume, while minimizing the absorbed dose of the adjacent normal tissue. 5–7 static conformal coplanar or noncoplanar portals were delivered for each fraction irradiation. The total dose delivered ranged from 65–70 Gy, with 2.5 Gy per fractionation, one fractionation per day, 5 days a week. Median follow-up time from 3-D CRT was 25 months (range: 12–36 months). Results: Over the follow-up period, local recurrence was observed in 3 patients, regional failure in 3, distant metastasis in 3, and six patients died; 88.2% (30/34) of the patient maintained local control, 82.4% (28/34) survived, and 76.5% (26/34) survived with no evidence of tumor. Acute complications were minor and few. The overall incidence of late complication was 20.6% (7/34), and severe complication was 14.7% (5/34), after re-irradiation with 3-D CRT. Conclusion: 3-D CRT is safety and effectiveness for most of the patients with locally recurrent NPC. Our preliminary results indicate a high local control rate and a low complication rate. The long-term curative effect and sequelae await further study.

Late course three-dimensional conformal radiotherapy for esophageal carcinoma

Objective： The aim of our study was to evaluate the clinical results and acute side effects of late course three-dimensional conformal radiotherapy （3DCRT） for esophageal carcinoma. Methods： From January 2004 to October 2006, 70 patients with esophageal carcinoma received late course 3DCRT. Their clinical data were analyzed retrospectively. The short-term clinical results, acute side effects, local control rates and survival rates were evaluated. Results： The complete response rate was 62.9%, partial response rate was 35.7%, and the overall response rate was 98.6%. The 1-, 2-and 3-year local control rates were 77.1%, 51.4% and 45.7%, respectively. The 1-, 2-and 3-year overall survival rates were 75.7%, 54.3% and 38.6%, respectively. The median survival time was 26 months. Conclusion： The technique of late course 3DCRT is an effective treatment for esophageal carcinoma and tend to improve the overall survival rate.

Dosimetric study of five-field intensity-modulated radiotherapy compared with conventional three-dimensional conformal radiotherapy for rectal cancer

Objective： The aim of the study was to compare the difference of dose distribution in clinical target volume and organ at risk （OAR） between five-field intensity-modulated radiotherapy （IMRT） and conventional three-dimensional conformal radiotherapy （3DCRT） in the radiotherapy of rectal cancer. Methods： Fifteen patients with rectal cancer treated with radio- therapy （RT） were retrospectively analyzed. Among the patients, seven received RT preoperatively and 8 postoperatively. The target volume and the OARs such as the small bowel, bladder and femoral heads were contoured for each patient. 3DCRT-plan and IMRT-plan were performed for each patient respectively, with the prescribed dose covering at least 95% of the planning target volume （PTV）. The conformity index （CI） and homogeneity index （HI） were used for evaluation of the dose distribution in the target volume, and the Dx% （the lowest dose to the x% volume of the OARs that received the highest dose of irradiation） and the mean dose were used for evaluation of the dose to OARs. Paired-T test was used for companson of the difference between the two plans. Results： In the IMRT-plan and 3DCRT-plan, the CI were 0.94 and 0.87 （P = 0.000） and the HI were 1.13 and 1.17, respectively （P = 0.001）. For small bowel, the D30%, D50% and the mean dose were 19.67 Gy, 15.13 Gy and 18.81 Gy in the IMRT-plan and 25.20 Gy, 22.20 Gy and 22.89 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For bladder, the D30%, D50%, and the mean dose were 24.80 Gy, 34.20 Gy and 28.70 Gy in the IMRT- plan, and 35.07 Gy, 44.67 Gy and 35.68 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For femoral heads, the D5% in the IMRT-plan and 3DCRT-plan were 40.6 Gy and 40.47 Gy, respectively （P = 0.936）, and the mean dose were 30.14 Gy and 25.57 Gy, respectively （P = 0.001）. Conclusion： Five-field IMRT-plan is better than 3DCRT-plan in the conformity and the dose homogeneity within target volume and also better in sparing the small bowel and bladder.

Evaluation of whole-course three-dimensional conformal radiotherapy combined with late-course accelerated hyperfractionated radiotherapy for esophageal carcinoma patients

Objective： The aim of the study was to evaluate the therapeutic effect and safety of whole-course three-dimensional conformal radiotherapy （3DCRT） combined with late-course accelerated hyperfractionated radiotherapy （LCAFR） on patients with esophageal carcinoma. Methods： one hundred and one patients with esophageal carcinoma were divided into two groups. Observing group （49 cases） were treated by whole-course 3DCRT. Patients in control group （52 cases） were treated by conventional radiotherapy. Clinical efficiencies and radiation toxicities were compared between two groups. Results： The side effects including radiation esophagitis （63.2%） and tracheitis （49.0%） decreased in observing group, but there was no significant difference between two groups （69.2% and 55.7% in controls）. The 1-, 2-and 3-year tumor local control rates and overall survival rates in the observing group were significantly improved compared with the control group, being respectively 87.8%, 75.5%, 63.3% vs 71.2%, 55.8%, 42.3% and 85.7%, 71.4%, 46.7% vs 69.2%, 51.9%, 26.9% （all P 0.05）. Conclusion： The therapeutic effect of whole-course 3DCRT combined with LCAFR for esophageal carcinomas is superior to conventional radiotherapy.

Comparison of efficacy between two boost treatments in residual tumor of nasopharyngeal carcinoma after radical radiotherapy

Objective： To compare the efficacy between stereotactic radiotherapy （SRT） and intracavitary brachytherapy （brachytherapy） in residual tumor of nasopharyngeal carcinoma （NPC） after treating with conventional external beam radiotherapy. Methods： 60 patients with residual tumor of NPC after radical external beam radiotherapy （range 68 to 72 Gy） were randomized into SRT group （27 patients） and brachytherapy group （33 patients）. Patients in SRT group received boost treatment of 10-20 Gy, 2-3 fractions, once every other day; patients in brachytherapy group were treated with boost 10-20 Gy, 5 Gy per fraction, twice a week. Results： Efficacy in the near future： in SRT group, the complete recession （CR）, partial recession （PR） and no change （NC） rates were 77.8% （21/27）, 18.5% （5/27）, 3.7% （1/27）, respectively and the efficacy rate was 96.3% （CR ＋ PR）; in brachytherapy group： the CR, PR and NC rates were 75.8% （25/33）, 18.2% （6/33）, 6.1% （2/33）, respectively and the efficacy rate was 93.9% （CR ＋ PR）. The efficacy rates of the above two groups were compared （x^2 = 0.032, P 〉 0.05）. Long term efficacy： in SRT group, 1-year and 3-year survival rates were 96.3%, 66.5% respectively and the median live time was 48 months; in brachytherapy group： 1-year and 3-year survival rates were 93.9%, 60.2% respectively and the median live time was 46 months. The survival rates of two groups were compared （x^2 = 0.172, P 〉 0.05）. Conclusion： Both boost techniques of SRT and brachytherapy had elevated efficacy in patients with residual tumor of NPC and there was no obvious difference between the efficacy of the near and long term in SRT and brachytherapy group.

Technical and Dosimetric Study of Four Facio-cervical Fields Conformal Radiotherapy for Nasopharyngeal Carcinoma

Objective： The aim of this study is to establish the methods of four facio-cervical fields＇ conformal radiotherapy （4F-CRT） for nasopharyngeal carcinoma （NPC）, and to optimize the methods for clinical practice. Methods and Materials： 40 patients with untreated NPC of T1-T4 （1997AJCC Staging System） were rolled into this study. Conventional and four ratio-cervical fields conform plans were designed for each patient using Pinnacle 8.0 three-dimension treatment planning system （3D-TPS）： 1） Improved plan, four ratio-cervical fields＇conform plans, anterior, posterior ratio-cervical and 2 lateral opposing facio-eervical fields; 2） Conventional plan, two lateral opposing facio-cervical fields only with the same dose delivered to the target in each plan, close volume histograms （DVHs） of the targets and normal organs, brain stem, spinal cord, parotid glands, and temporal mandibular joints （TMJs） were compared and the dose distribution were evaluated. Results： 1） The dose distribution of the improved plan could meet the requirements for the target volume. 2） There was not any significant difference in the dose of spinal cord between the two plans. The mean doses of Dmax for brain stem in conventional plan were much lower than those in the improved plan, though both were within safety limits. 3） Compared with the conventional plans, the improved plan significantly decreased the hotspot areas in the target volume and had better parotid glands and temporal mandibular joints sparing effect. Conclusion： Compared with the conventional plan, the improved plan provides satisfactory dose coverage to the tumor volume and better sparing of the parotid gland, TMJs and other normal tissues in external beam radiotherapy of NPC.

Initial outcome of induction chemotherapy followed by radiotherapy and concurrent weekly paclitaxel for stage Ⅲ non-small cell lung cancer

Objective： The aim of our study was to evaluate the toxicity and efficacy of induction chemotherapy （ICT） followed by three-dimensional conformal radiotherapy （3D CRT） and concurrent weekly paclitaxel on unresectable non-small cell lung cancer （NSCLC）. Methods： Stage III NSCLC patients with favorable conditions were treated with 2 to 4 cycles of carboplatin （AUC = 5-6, dl） combined with paclitaxel （175 mg/m〈 dl）, then followed by weekly paclitaxel （40 mg/m2） and concurrent 3D CRT within 3-4 weeks. The prescription dose was given as high as possible under the condition that V20 〈 31% and spinal cord dose 〈 50 Gy. Results： Thirty-one patients were enrolled. ICT was well tolerated. During the concurrent chemoradiotherapy, the treatment of 3 patients was ended ahead of the schedule because of severe pulmonary and heart toxicities; the treatment of 2 patients was delayed for 7 and 12 days because of fatigue. Myelosuppression was mild （16/31）： all were grade 1-2 except 1 was grade 3. Lymphocytopenia was more obvious （29/31, grade 3 in 21）. Three patients developed grade 3 radiation-induced esophagitis, and 2 developed grades 3-4 radiation-induced pneumonitis. Two developed grade 3 esophageal stricture. No grades 3-4 pulmonary fibrosis was observed. The overall response rate was 74.1%. The 1-, 2-, 3-year overall survival rates were 74.2%, 41.9%, and 34.6%, respectively, with the median survival time of 18.5 months. The 1-, 2-, 3-year local progression-freely survival rates were 64.5%, 32.3%, and 20.5%, respectively, with the median local progression-freely survival time of 14.3 months. Conclusion： The program of ICT followed by weekly paclitaxel and 3D CRT is accomplished in most of the favorable stage III NSCLC patients. The toxicity is tolerable, and the response rate is inspiriting.

鼻咽癌放化疗治疗患者外周血PD-1及免疫指标水平的变化及其临床意义

目的探讨鼻咽癌放化疗治疗患者外周血程序性死亡受体1(PD-1)及免疫指标水平的变化及其临床意义。方法回顾性选取2020年1月至2023年江苏省肿瘤医院收治的90例鼻咽癌患者,所有患者均经病理确诊并接受放化疗治疗,采集其血液样本之后采用流式细胞术对不同时间段(治疗前、新辅助化疗后、放疗后)外周血淋巴细胞亚群比例、外周血PD-1、CD8^(+)CD28^(+)细胞比例的水平变化予以动态监测并比较。结果鼻咽癌患者新辅助化疗后CD3^(+)、CD4^(+)细胞比例、CD4^(+)/CD8^(+)比值分别为(72.28±8.37)%、(39.27±8.58)%、1.58±0.67,均明显高于治疗前,CD3-CD16^(+)CD56^(+)、CD19^(+)细胞比例分别为(18.27±8.38)%、(7.87±4.08)%,均明显低于治疗前,差异均有统计学意义(P<0.05);新辅助化疗后与治疗前的CD8^(+)细胞比例比较,差异无统计学意义(P>0.05)。鼻咽癌患者新辅助化疗之后CD8^(+)CD28^(+)细胞比例为(10.68±3.87)%,明显高于治疗前,差异有统计学意义(P<0.05);新辅助化疗后与治疗前的外周血PD-1水平比较,差异无统计学意义(P>0.05)。放疗后与治疗前的CD3^(+)细胞比例比较,差异无统计学意义(P>0.05);鼻咽癌患者放疗后CD4^(+)细胞比例、CD4^(+)/CD8^(+)比值、CD19^(+)细胞比例分别为(26.68±6.09)%、0.88±0.29、(3.69±2.36)%,均明显低于治疗前,CD8^(+)、CD3-CD16^(+)CD56^(+)细胞比例分别为(31.03±8.08)%、(27.39±10.26)%,均明显高于治疗前,差异均有统计学意义(P<0.05)。鼻咽癌患者放疗后CD8^(+)CD28^(+)细胞比例为(7.08±2.57)%,明显低于治疗前,外周血PD-1水平为(13.38±6.27)%,明显高于治疗前,差异均有统计学意义(P<0.05)。结论新辅助化疗之后鼻咽癌患者外周血T细胞亚群比值处于持续上调趋势,而放疗完成后处于下降趋势,表明鼻咽癌患者于放疗完成后免疫功能受损;放疗完成后鼻咽癌患者T细胞PD-1表达水平明显上调,提示PD-1抑制剂最佳使用时间可能为放化疗完成时,抗PD-1维持治疗可发挥持久、高效的抗肿瘤作用。

长链非编码RNA-ROR介导上皮-间质转化对鼻咽癌细胞放疗抵抗作用的体外研究

目的 探讨lncRNA-ROR介导上皮-间质转化在鼻咽癌细胞放疗抵抗中的作用。方法 将鼻咽癌细胞CNE2分为空白组、阴性对照组、lncRNA-ROR沉默组,进行相应的处理。将CNE2细胞分为空白组、放疗组、放疗+阴性对照组、放疗+lncRNA-ROR过表达组(放疗处理为6 Gy射线照射24 h),进行相应的处理。用CCK-8法检测CNE2增殖能力,通过细胞划痕实验和Transwell 细胞迁移实验检测细胞迁移能力,用流式细胞术检测细胞凋亡的情况,用蛋白印迹法检测凋亡相关蛋白和上皮-间质转化相关蛋白的表达。结果 与空白组、阴性对照组相比,抑制lncRNA-ROR表达48、72 h后鼻咽癌细胞CNE2的增殖能力均减弱(均P<0.05)。抑制lncRNA-ROR表达后鼻咽癌细胞CNE2的迁移率低于阴性对照组(P<0.05),而放疗+lncRNA-ROR过表达组CNE2细胞的迁移能力高于放疗组与放疗+阴性对照组(均P<0.05)。与放疗组、放疗+阴性对照组相比,放疗+lncRNA-ROR过表达组CNE2细胞的凋亡率均降低(均P<0.05)。抑制lncRNA-ROR后,活化的caspase 3、caspase 9蛋白表达均较空白组和阴性对照组升高(均P<0.05);而放疗+lncRNA-ROR过表达组活化的caspase 3、caspase 9蛋白表达均较放疗组和放疗+阴性对照组下降(均P<0.05)。抑制lncRNA-ROR可导致上皮标志蛋白(E-钙黏蛋白、β-联蛋白)表达升高,间质标志蛋白(N-钙黏蛋白、波形蛋白)表达下降(均P<0.05);而与放疗组和放疗+阴性对照组相比,放疗+lncRNA-ROR过表达组CNE2细胞的上皮标志蛋白表达下降、间质标志蛋白表达升高(均P<0.05)。结论 lncRNA-ROR可通过调控鼻咽癌细胞增殖、迁移、凋亡及上皮-间质转化影响其放疗抵抗,是逆转鼻咽癌细胞放疗抵抗的潜在靶点。

特瑞普利单抗联合卡培他滨、放疗治疗中晚期鼻咽癌的临床研究

目的探讨特瑞普利单抗联合卡培他滨、放疗治疗中晚期鼻咽癌的临床效果。方法前瞻性选取2021年6月至2023年6月海南省人民医院收治的中晚期鼻咽癌患者80例。按照随机数字表法将其分为放化疗组和联合组,每组各40例。放化疗组给予卡培他滨、放疗进行治疗,联合组在放化疗组的基础上联合特瑞普利单抗进行治疗,比较两组客观缓解率(ORR)以及治疗前、后患者血清肿瘤标志物[鳞状细胞癌抗原(SCC-Ag)、高迁移率族蛋白B1(HMGB1)与细胞角蛋白19片段抗原21-1(CYFRA21-1)]水平、免疫功能(CD4^(+),CD8^(+)、CD4^(+)/CD8^(+))变化情况,并统计观察两组不良反应及复发、转移情况。结果联合组ORR为90.00%,显著高于放化疗组(70.00%),差异有统计学意义(P<0.05)。治疗3个月后,两组患者SCC-AG、HMGB1、CYFRA21-1水平均较治疗前降低,且联合组SCC-AG、HMGB1、CYFRA21-1水平分别为(1.45±0.37)ng/mL、(108.04±14.46)ng/mL、(3.56±1.04)μg/L,均低于放化疗组[(4.43±0.95)ng/mL、(136.52±16.72)ng/mL、(7.29±1.81)μg/L],差异均有统计学意义(P<0.05)。治疗3个月后,两组患者CD4^(+)、CD4^(+)/CD8^(+)水平均较治疗前升高,联合组CD8^(+)水平较治疗前降低,且联合组的CD4^(+)、CD4^(+)/CD8^(+)水平分别为(38.25±4.92)%、1.65±0.26,均高于放化疗组[(35.14±4.68)%、1.34±0.22],CD8^(+)水平为(23.22±2.89)%,低于放化疗组[(25.36±2.93)%],差异均有统计学意义(P<0.05)。治疗期间,两组不良反应总发生率比较,差异无统计学意义(P>0.05)。治疗后,联合组局部复发率为10.00%,显著低于放化疗组(27.50%),差异有统计学意义(P<0.05)。治疗后,联合组转移率为7.50%,放化疗组转移率为15.00%,两组比较差异无统计学意义(P>0.05)。结论采用特瑞普利单抗联合卡培他滨、放疗治疗中晚期鼻咽癌可提高患者临床疗效,降低肿瘤标志物水平,改善免疫功能,且安全性可靠。

基于最佳证据的鼻咽癌放疗致吞咽功能障碍患者康复指导流程图的构建及应用

目的检索并筛选总结鼻咽癌放疗致吞咽功能障碍患者康复的最佳证据,基于最佳证据构建康复指导流程图并应用于临床。方法检索PubMed、中国知网、Elsevier等数据库关于鼻咽癌放疗致吞咽功能障碍患者康复的相关证据,包括指南、证据总结、系统评价等,检索时限为建库至2023年8月31日。由2名拥有循证护理背景研究者对纳入文献进行质量评价核对及证据提取,构建康复指导流程图并应用于临床。选取2023年3月-8月我院收治的鼻咽癌放疗致吞咽功能障碍患者100例作为对照组,采用常规康复干预;选取2023年10月-2024年3月我院收治的鼻咽癌放疗致吞咽功能障碍患者100例作为观察组,采用基于最佳证据的康复指导流程图干预。比较两组临床疗效及干预前后吞咽功能评分量表(GUSS)、安德森吞咽困难量表(MDADI)、吞咽生命质量量表(SWAL-QOL)、营养风险筛查表2002(NRS2002)评分。结果共获得专家共识1篇、证据总结4篇、最佳实践推荐1篇、系统综述3篇、Meta分析1篇,提取30条最佳证据,总结为康复前、吞咽障碍评估、康复训练、营养干预、口干症、口腔洁净及康复后7个维度,最终选取其中的10条证据构建康复指导流程图并应用于临床。观察组临床疗效优于对照组(P<0.05),干预后GUSS、MDADI及SWAL-QOL评分高于对照组,NRS2002评分低于对照组(P<0.05)。结论基于最佳证据的鼻咽癌放疗致吞咽功能障碍患者的康复指导流程图构建及应用,可提高患者治疗效果,改善吞咽障碍症状,降低营养风险,提升生活质量。

305例鼻咽癌调强放疗预后因素分析

背景与目的:放疗是鼻咽癌治疗的有效手段。本研究目的是分析大样本量调强放疗(intensity-modulated radiation therapy,IMRT)治疗鼻咽癌的效果、不良反应并探索其预后因素。方法:分析从2003年9月到2006年9月在福建省肿瘤医院接受IMRT的305例鼻咽癌患者临床资料并作生存分析。肿瘤靶区的处方剂量为66～69.75Gy/30～33次。Ⅲ～Ⅳa期患者接受了以铂类为基础的化疗。结果:中位随访时间35个月(5～61个月)。分别有16、8和39例出现局部﹑颈部淋巴结复发及远处转移。3年局控率﹑区域淋巴结控制率﹑无远处转移率﹑无瘤生存率及总生存率分别为94.3%﹑97.7%﹑86.1%﹑80.3%和89.1%。多因素分析表明T分期并不影响局控率及总生存率(P>0.05),N分期是影响总生存率(P=0.000)、无远处转移率(P=0.000)及无瘤生存率(P=0.003)的独立预后因素。同步和辅助化疗不改善Ⅲ～Ⅳa期患者预后(P>0.05)。严重的急性不良反应包括Ⅲ度皮肤反应14例(4.6%)、Ⅲ度口腔黏膜反应90例(29.5%)及Ⅲ～Ⅳ度骨髓抑制20例(6.5%);IMRT治疗两年后Ⅱ度口干发生率7%,无Ⅲ～Ⅳ度口干。结论:IMRT治疗鼻咽癌可以获得较好的局部区域淋巴结控制率及总生存率,不良反应可耐受。N分期是影响预后的主要因素,为降低远处转移率进一步提高疗效还需探讨化疗的意义。

初治鼻咽癌调强放疗与常规放疗的同期对照研究

背景与目的:调强适形放疗在鼻咽癌治疗中的应用逐渐增多,取得了较好的局部控制率。本研究探讨与常规放疗比较,调强放疗能否提高鼻咽癌患者的生存率并减少放射性损伤。方法:选择2003年11月至2005年12月在福建省肿瘤医院行调强放疗的初治鼻咽癌患者190例为调强放疗组,并按1∶1配对选择同期行常规放疗的190例初治鼻咽癌患者作为对照组,两组共380例患者。随访两组的生存状况以及急性和慢性放射性损伤发生情况,对两组进行生存分析,并比较两组的疗效及放射性损伤的发生率及严重程度。结果:调强放疗组4年无局部复发生存率和局部区域控制率均高于常规放疗组(89.8%vs.80.7%,P=0.029;90.4%vs.78.3%,P=0.0107);而两组的4年无远处转移生存率、无进展生存率和总生存率差异均无统计学意义(88.6%vs.83.4%,79.4%vs.64.8%,88.9%vs.75.8%,P值均>0.05)。调强放疗患者的急性口干、颈部纤维化、张口困难的严重程度以及放疗后6个月、1、2、3、4年的口干反应均明显轻于常规放疗(P值均﹤0.05);但两组的急性黏膜反应、骨髓抑制和慢性听力损伤、放射性颅神经损伤差异均无统计学意义(P值均>0.05)。结论:调强放疗可提高初治鼻咽癌患者的无局部复发生存率及局部区域控制率,并能减轻患者的部分急慢性放射性损伤,但未能提高总生存率。

改进鼻咽癌外照射技术的前瞻性临床研究

目的：前瞻性地观察改进鼻咽癌外照射技术对临床治疗疗效的影响。方法：从1992年3月至1995年6月，124例初治鼻咽癌病人按T、N、M分层配对分为改进方案治疗组(先面颈联合野照射40～45Gy，后用面颈分野照射至根治量或预防量，采用低熔点挡块技术)或常规方案治疗组(全程放疗均采用面颈分野)进行治疗，然后比较两组的近远期疗效及其正常组织的早发和晚发放射反应。结果：放疗后2～3月的CT检查显示改进方案治疗组原发灶完全消退率(58.06％)高于常规方案治疗组(30.64％)(P<0.05)，而改进方案治疗组口腔粘膜和胃肠早发放射反应轻于常规方案治疗组(P<0.05)。远期随访显示改进方案治疗组1、3和5年总的生存率、无瘤生存率和无局部区域复发率均高于常规方案治疗组(P<0.05)，且改进方案治疗组的后组颅神经放射损伤率(4.8％)低于常规方案治疗组(16.1％)(P<0.05)。结论：与常规方案相比，改进方案提高了鼻咽癌的局部区域控制率，提高了病人的生存率和生存质量，值得推广应用。

鼻咽癌放射治疗失败原因分析

目的：研究鼻咽癌放射治疗失败原因，为制定鼻咽癌治疗策略提供依据。方法： 1992年 8月至 1993年 12月， 621例鼻咽癌患者Ⅰ～Ⅳ期分别为 5.5％， 25.0％ ,47.8％及 21.7％。治疗前均行 CT或 MR检查，经鼻咽病理证实的非转移鼻咽癌接受根治性放射治疗。鼻咽腔内残留病灶，给予腔内后装治疗。随诊方法根据症状、体征、病理学及相关部位的影像学检查，生存分析用 Kaplan- Meier法 ,生存指标采用总生存、无瘤生存、无局部复发及无远处转移生存率。失败原因采用 5年累积局部、颈部复发及远处转移率。 结果： 5年总生存率、无瘤生存率分别为 61.2％、 57.3％。 T1、 T2、 T3、 T4的 5年局部复发率分别为 7.6％、 12.9％、 24.1％及 41.3％ ;N0、 N1、 N2、 N3的颈部复发率分别为 2.3％、 7.5％、 12.0％及 43.6％； N0、 N1、 N2、 N3的 5年远处转移率分别依次为 6.9％、 19.5％、 31.3％及 53.7％。 75.7％的远处转移为单纯转移。治疗失败的患者中 14.4％合并局部、颈部复发及远处转移中的两项或两项以上。结论：远处转移仍为鼻咽癌治疗失败主要原因， T分期的严重程度与局控率密切相关。就放射治疗而言，精确的治疗计划可望提高鼻咽癌的生存率。

鼻咽癌调强放疗和常规放疗早期反应的对照观察

目的观察鼻咽癌病人调强放疗和常规放疗的早期治疗结果和早期并发症情况。方法78例Ⅰ～Ⅲ期鼻咽癌病人分为调强放疗组(38例)和常规放疗组(40例)。常规放疗采用面颈联合野+锁骨上野及耳前野+后颈电子线野,靶区剂量2Gy/(次·天);调强放疗先设定7～9个适形野,再设定80～100个调强子野照射,靶区剂量2.2Gy/(次·天)。研究调强放疗和常规面颈联合野放疗病人的腮腺、脊髓、临床靶区和计划靶区的平均受照体积,观察放疗期间病人的皮肤反应、口干(腮腺)反应和口腔黏膜反应。结果所有病人放疗后鼻咽及周围病灶明显消退。腮腺、脊髓、临床靶区和计划靶区的受照体积调强放疗组分别为(30±4.8)%、(56±6.7)%、(95±8.6)%、(92±8.1)%,常规放疗组分别为(98±9.4)%、(56±10.7)%、(100±9.7)%、(99±9.5)%,调强放疗组腮腺受照体积明显低于常规放疗组。调强放疗组的皮肤反应多为Ⅰ级,口干(腮腺)反应多为Ⅰ、Ⅱ级,口腔黏膜反应为Ⅰ、Ⅱ级。而常规放疗组的皮肤反应及口干(腮腺)反应多为Ⅱ、Ⅲ级,口腔黏膜反应为Ⅱ、Ⅲ级。其中口干(腮腺)反应、皮肤反应、口腔黏膜反应Ⅱ、Ⅲ级者调强放疗组明显少于常规放疗组。另外,调强放疗组的放疗时间为45.0±4.4天,少于常规放疗组的51.0±5.3天。但调强放疗组放疗后鼻咽腔炎症反应较重。结论使用调强技术可明显减轻鼻咽癌病人放疗的口干和皮肤反应等早期放疗反应,并能缩短放疗时间。

Ⅲ、Ⅳ a期鼻咽癌患者放疗同期化疗加辅助化疗的疗效

背景与目的:较多研究认为放疗前诱导化疗未能提高中晚期鼻咽癌的生存率,对放疗后的辅助化疗能否提高中晚期鼻咽癌的生存率有争议。有作者报道同期放化疗能提高中晚期鼻咽癌患者的疗效。本研究着重探讨放疗同期化疗加辅助化疗治疗Ⅲ、Ⅳa期鼻咽癌的疗效。方法:将80例Ⅲ、Ⅳa期鼻咽癌患者随机分为放疗同期化疗加辅助化疗组(研究组)及单纯放疗组(对照组),每组各40例。研究组于放疗第一周开始使用同期化疗,顺铂25mg/m2静脉滴注,每周一次,连用6周。辅助化疗于放疗结束后一个月开始,顺铂25mg/m2,静脉滴注,第1～3天;氟尿嘧啶1000mg/m2,静脉滴注,第1～3天。每月一次,连用3次。放疗使用常规分割放疗,鼻咽部总剂量70Gy。对照组放疗方法与放疗加化疗组相同,不使用化疗。生存率采用Kaplan-Meier法,生存期的差别比较用log-rank检验,计数资料组间差异用卡方检验。结果:治疗后,研究组和对照组分别有34例和32例鼻咽肿瘤达到CR者(χ2=0.35,P>0.05);颈部淋巴结达到CR者分别为37例和30例(χ2=4.50,P<0.05)。研究组1、3、5年生存率分别为92.7%、78.6%、64.2%,对照组1、3、5年生存率分别为81.2%、52.7%、42.3%,两组比较差异有显著性(P<0.01)。研究组1、3、5年无瘤生存率分别为91.2%、76.7%、63.5%,对照组1、3、5年无瘤生存率分别为78.2%、51.9%、40.3%,两组比较差异有显著性(P<0.01)。5年累积远处转移发生率研究组为15.0%,对照组为35.0%,两组比较差异有显著性(χ2=4.27,P<0.05)。Ⅲ度口腔粘膜炎发生率研究组为75.0%,对照组为25.0%(χ2=20.00,P<0.01)。结论:同期加辅助化疗联合放疗较单纯放疗提高了Ⅲ、Ⅳa期鼻咽癌的颈部淋巴结完全缓解率以及1、3、5年生存率和无瘤生存率,显著降低了远处转移的发生率,但增加了Ⅲ度口腔粘膜炎的发生率。

鼻咽癌咽旁间隙侵犯对预后的影响

目的：探讨鼻咽癌咽旁间隙侵犯程度与预后的关系。方法：２１９例初诊鼻咽癌经ＣＴ扫描后将咽旁间隙侵犯程度分为：０级：无侵犯；Ⅰ级：轻度侵犯；Ⅱ级：重度侵犯。应用ＫａｐｌａｎＭｅｉｅｒ方法和Ｃｏｘ模型对放疗后５年的局控率、无远处转移生存率、无瘤生存率及影响预后因素进行分析和评价。结果：咽旁０、Ⅰ、Ⅱ级侵犯的５年无瘤生存率分别为６９９１％、６０７２％、３２１３％，后者明显低于前两者（Ｐ≤０．０００３），而前两者比较则无差异（Ｐ＝０．４７３６）；Ⅱ级侵犯的５年鼻咽局控率（６８７％）、颈部局控率（７６４％）和无远处转移生存率（５８５％）也明显低于０级（分别为８９９％、９５３％和８８０％）和Ⅰ级（分别为８３７％、９５８％和８１５％），统计学上有显著差异。多因素Ｃｏｘ模型显示Ｎ分期、咽旁侵犯程度和副鼻窦（包括海绵窦）侵犯是影响预后的显著性因素。结论：咽旁间隙重度（Ⅱ级）侵犯是鼻咽癌预后较差的重要影响因素之一。

鼻咽癌远处转移的预后因素分析

背景与目的:鼻咽癌远处转移的发生率较高,已成为鼻咽癌治疗失败的主要原因之一。本研究探讨转移性鼻咽癌预后的影响因素,为临床选择治疗方案提供依据。方法:从1997年1月至2003年6月,共有128例在确诊时或在治疗期间发生远处转移的鼻咽癌患者在我院住院治疗,其中男性112例,女性16例,中位年龄48岁(15～70岁)。放疗加化疗54例,单独化疗48例,单纯放射治疗14例,未治疗12例。用Kaplan-Meier法计算生存率,用log-rank检验各组生存率。采用Cox逐步回归模型进行多因素分析。结果:全组患者1、2、3年生存率分别为60.9%、34.4%、14.1%,中位生存时间为15.6(0.85～96.63)个月。单因素分析显示,年龄(P=0.038)、治疗方式(P=0.041)、化疗程数(P=0.034)和近期疗效(P=0.007)是转移性鼻咽癌预后的影响因素。多因素分析显示,性别(P=0.013)、N分期(P=0.011)、化疗程数(P=0.032)和近期疗效(P=0.000)是影响转移性鼻咽癌预后的独立因素。结论:性别、化疗程数和近期疗效是影响转移性鼻咽癌预后的独立因素。