中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2011年
5期
374-378
,共5页
周彬%石梅%王建华%罗山泉%许曼%赵丽娜%李剑平%肖锋%刘晓莉%谭丽娜%龙晓丽
週彬%石梅%王建華%囉山泉%許曼%趙麗娜%李劍平%肖鋒%劉曉莉%譚麗娜%龍曉麗
주빈%석매%왕건화%라산천%허만%조려나%리검평%초봉%류효리%담려나%룡효려
鼻咽肿瘤/放射疗法%放射疗法,调强%预后
鼻嚥腫瘤/放射療法%放射療法,調彊%預後
비인종류/방사요법%방사요법,조강%예후
Nasopharyngeal neoplasms/radiotherapy%Radiotherapy,intensity-modulated
目的 分析中国西北地区初治鼻咽癌调强放疗(IMRT)疗效、不良反应和影响预后因素。方法 2006-2009年在本院接受全程IMRT的133例患者入组分析,其中22例单纯放疗,111例接受以铂类为基础的同期放化疗。鼻咽大体肿瘤体积66.0～76.6 Gy分30～33次,颈部阳性淋巴结66.0～72.4 Gy分30 ～33次,高危临床靶体积56.0～63.5 Gy分28～33次,低危临床靶体积50.4 ～53.2 Gy分28次。结果随访率为97.7％,随访时间满2、3年者分别为37、44例。1、2、3年总生存率分别为93.8％、88.3％、83.2％;局部控制率分别为99.2％、95.4％、95.4％;区域控制率分别为99.2％、96.8％、96.8％;无远处转移率分别为82.8％、79.8％、79.8％;无瘤生存率分别为84.3％、76.7％、76.7％。多因素分析显示N分期、年龄及放疗前是否贫血是影响总生存率的因素(x2 =5.56、9.10、4.89,P=0.018、0.003、0.027),同时N分期还是影响无瘤生存率的因素(x2=8.98,P=0.003)。3级急性不良反应率分别为皮肤1.4％、口腔黏膜34.7％、唾液腺20.1％、骨髓抑制1.4％。全组未观察到4级急性和晚期不良反应。结论 中国西北地区初治鼻咽癌患者IMRT能获得较好局部、区域淋巴结控制率及总生存率,不良反应可耐受,远处转移仍是治疗失败的最主要模式,N分期、发病年龄、放疗前有无贫血是影响生存的主要因素。
目的 分析中國西北地區初治鼻嚥癌調彊放療(IMRT)療效、不良反應和影響預後因素。方法 2006-2009年在本院接受全程IMRT的133例患者入組分析,其中22例單純放療,111例接受以鉑類為基礎的同期放化療。鼻嚥大體腫瘤體積66.0～76.6 Gy分30～33次,頸部暘性淋巴結66.0～72.4 Gy分30 ～33次,高危臨床靶體積56.0～63.5 Gy分28～33次,低危臨床靶體積50.4 ～53.2 Gy分28次。結果隨訪率為97.7％,隨訪時間滿2、3年者分彆為37、44例。1、2、3年總生存率分彆為93.8％、88.3％、83.2％;跼部控製率分彆為99.2％、95.4％、95.4％;區域控製率分彆為99.2％、96.8％、96.8％;無遠處轉移率分彆為82.8％、79.8％、79.8％;無瘤生存率分彆為84.3％、76.7％、76.7％。多因素分析顯示N分期、年齡及放療前是否貧血是影響總生存率的因素(x2 =5.56、9.10、4.89,P=0.018、0.003、0.027),同時N分期還是影響無瘤生存率的因素(x2=8.98,P=0.003)。3級急性不良反應率分彆為皮膚1.4％、口腔黏膜34.7％、唾液腺20.1％、骨髓抑製1.4％。全組未觀察到4級急性和晚期不良反應。結論 中國西北地區初治鼻嚥癌患者IMRT能穫得較好跼部、區域淋巴結控製率及總生存率,不良反應可耐受,遠處轉移仍是治療失敗的最主要模式,N分期、髮病年齡、放療前有無貧血是影響生存的主要因素。
목적 분석중국서북지구초치비인암조강방료(IMRT)료효、불량반응화영향예후인소。방법 2006-2009년재본원접수전정IMRT적133례환자입조분석,기중22례단순방료,111례접수이박류위기출적동기방화료。비인대체종류체적66.0～76.6 Gy분30～33차,경부양성림파결66.0～72.4 Gy분30 ～33차,고위림상파체적56.0～63.5 Gy분28～33차,저위림상파체적50.4 ～53.2 Gy분28차。결과수방솔위97.7％,수방시간만2、3년자분별위37、44례。1、2、3년총생존솔분별위93.8％、88.3％、83.2％;국부공제솔분별위99.2％、95.4％、95.4％;구역공제솔분별위99.2％、96.8％、96.8％;무원처전이솔분별위82.8％、79.8％、79.8％;무류생존솔분별위84.3％、76.7％、76.7％。다인소분석현시N분기、년령급방료전시부빈혈시영향총생존솔적인소(x2 =5.56、9.10、4.89,P=0.018、0.003、0.027),동시N분기환시영향무류생존솔적인소(x2=8.98,P=0.003)。3급급성불량반응솔분별위피부1.4％、구강점막34.7％、타액선20.1％、골수억제1.4％。전조미관찰도4급급성화만기불량반응。결론 중국서북지구초치비인암환자IMRT능획득교호국부、구역림파결공제솔급총생존솔,불량반응가내수,원처전이잉시치료실패적최주요모식,N분기、발병년령、방료전유무빈혈시영향생존적주요인소。
Objective To evaluate the long term outcomes, toxicities and prognostic factors of the patients in Northwest China with nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT). Methods From January 2006 to December 2009, 133 NPC Patients were treated by IMRT in Xijing Hospital, the Fourth Military Medical University. There were 22 treated by radiotherapy alone, 111 treated by platinum-based current chemo-radiothreapy. The prescription dose to the gross tumor volume was 66 - 76. 6 Gy/30 - 33 fractions, positive lymph nodes was 66. 0 - 72. 4 Gy/30 - 33 fractions.The higher and lower risk clinical target volume were irradiated with 56. 0 - 63. 5 Gy/28 - 33 fractions and 50. 4 -53. 2 Gy/28 fractions respectively. Results The follow-up rate was 97. 7％. Follow-up time more than 2years,3years were 37cases ,44cases. The l-,2-and 3-year overall survival (OS) were 93. 8％, 88. 3％and 83.2％ ; local control rate were 99. 2％ ,95.4％ and 95.4％ ; regional control rate ( RC ) were 99. 2％,96. 8％ and 96.8％ ; and distant metastasis-free rate (DMFR) were 82. 8％, 79. 8％ and 79. 8％ ; the disease-free survival (DFS) were 84. 3％ ,76. 7％ and 76. 7％, respectively. Multivariate analyses revealed that N stage, age and anemia before radiotherapy were independent predietors for OS (x2 =5.56,9. 10,4.89,P=0. 018,0.003,0.027), and N stage was also independent predictors for DFS (x2 =8.98,P=0.003). The grade 3 acute toxicities were mueositis (34.7％), xerostomia (20. 1％ ), skin reaction ( 1.4 ％ ) and leucocytopenia ( 1. 4 ％ ). No grade4 acute and late toxieities were detected. Conclusions IMRT with or without chemotherapy achieved good long term survival in nasopharyngeal carcinoma treated by intensity-modulated radiotherapy, especially in LC and RC. Distant metastasis becomes the main treatment failure. N stage, age, and anemia before radiotherapy were the main prognostic factors in nasopharyngeal cancer patients.
