CAJ | 학술논문

背景与目的:鼻咽癌一侧或双侧颈部淋巴结阴性者颈部的区域预防照射范围及剂量尚无定论.本研究通过回顾性分析,探讨鼻咽癌影像学诊断NO期患者颈部预防野照射方式,并分析颈部淋巴结复发因素及预后因素.方法:收集2002年1月至2004年12月205例NO期鼻咽癌患者资料,治疗前均行鼻咽部和颈部影像学检查.采用直线加速器产生的6～8 MV高能X线,以面颈联合野为主的放疗技术,鼻咽原发灶照射剂量为60～80 Gy,颈部剂量为46～64 Gy.常规分割、连续照射.按颈部预防照射范围将患者分为两组,半颈预防组和全颈预防组.60例进行了化疗.随访时间3～68个月,中位随访时间44个月.累积生存率采用Kaplan-Meier计算,对生存率的差异采用log-rank进行显著性检验,多因素分析采用Cox风险比例模型前进法.结果:205例NO期鼻咽癌患者,3年总生存率及无瘤生存率分别为92.9%、91.9%.半颈、全颈预防组淋巴结复发率分别为2.27%、0,T1、T2、T3、T4期患者的颈部复发率分别为0、3.08%、0、0,鼻咽无复发时、复发时的颈部淋巴结复发率分别为1.03%、0,各组淋巴结复发率比较差异均无统计学意义(P>0.05).半颈预防组的1年、3年总生存率分别为97.7%、94.2%,全颈预防组1年、3年总生存率分别为97.4%、91.9%(P=0.950);半颈预防组的1年、3年无瘤生存率分别为96.6%、92.9%,全颈预防组1年、3年无瘤生存率分别为95.6%、90.9%(P=0.730).NO期鼻咽癌预后多因素分析,性别(P=0.039)、T分期(P=0.004)为其独立预后因素.结论:NO期鼻咽癌行半颈预防(Ⅱ、Ⅲ、Ⅴ A区)应已足够.NO期鼻咽癌颈部淋巴结复发率与咽旁间隙受侵、T分期、鼻咽复发率无关.NO期鼻咽癌的独立预后因素有性别、T分期.
배경여목적:비인암일측혹쌍측경부림파결음성자경부적구역예방조사범위급제량상무정론.본연구통과회고성분석,탐토비인암영상학진단NO기환자경부예방야조사방식,병분석경부림파결복발인소급예후인소.방법:수집2002년1월지2004년12월205례NO기비인암환자자료,치료전균행비인부화경부영상학검사.채용직선가속기산생적6～8 MV고능X선,이면경연합야위주적방료기술,비인원발조조사제량위60～80 Gy,경부제량위46～64 Gy.상규분할、련속조사.안경부예방조사범위장환자분위량조,반경예방조화전경예방조.60례진행료화료.수방시간3～68개월,중위수방시간44개월.루적생존솔채용Kaplan-Meier계산,대생존솔적차이채용log-rank진행현저성검험,다인소분석채용Cox풍험비례모형전진법.결과:205례NO기비인암환자,3년총생존솔급무류생존솔분별위92.9%、91.9%.반경、전경예방조림파결복발솔분별위2.27%、0,T1、T2、T3、T4기환자적경부복발솔분별위0、3.08%、0、0,비인무복발시、복발시적경부림파결복발솔분별위1.03%、0,각조림파결복발솔비교차이균무통계학의의(P>0.05).반경예방조적1년、3년총생존솔분별위97.7%、94.2%,전경예방조1년、3년총생존솔분별위97.4%、91.9%(P=0.950);반경예방조적1년、3년무류생존솔분별위96.6%、92.9%,전경예방조1년、3년무류생존솔분별위95.6%、90.9%(P=0.730).NO기비인암예후다인소분석,성별(P=0.039)、T분기(P=0.004)위기독립예후인소.결론:NO기비인암행반경예방(Ⅱ、Ⅲ、Ⅴ A구)응이족구.NO기비인암경부림파결복발솔여인방간극수침、T분기、비인복발솔무관.NO기비인암적독립예후인소유성별、T분기.
Background and Objective:It is controversial for the irradiation level and dose of the regional prevention for nasopharyngeal cancer (NPC) with one or both cervical lymph node-negative neck.This study was to analyze the prophylactic irradiation of cervical lymph nodes for Stage-N0 NPC patients.Methods:From January 2002 to December 2004,205 patients with NPC,whose negative cervical lymph nodes were diagnosed by imageology,were analyzed retrospectively.CT scan or MRI before treatment was performed to every patients.Six to 8 MV photons and facio-cervical portals were used in radiotherapy.Sixty to 80 Gy had been given to nasopharynx,and 46 to 64 Gy to clinically negative lymph nodes.Consecutive radiotherapy was performed employing conventional fraction of 2 Gy per fraction,once a day and total 5 fractions per week.Chemotherapy was administered to 60 patients.Median follow-up was 44 months.The accumulated survival was calculated according to the Kaplan-Meier method.Log-rank test was used to compare the survival difference.Cox proportional hazards model was used for multivariate analysis.A total of 205 patients with Stage-N0 NPC were divided into the upper-neck group and whole-neck group,Results:The 3-year overall survival rate (OS) was 92.9% and the 3-year disease-free survival rate (DFS) was 91.9% in 205 patients with Stage-NO NPC.There were 88 patients who had received prophylactic irradiation involved in the upper neck,while the other 117 in the whole neck.The rate of regional failure in the upper-neck group and in the whole-neck group were 2.27% and 0% (P >0.05),respectively.The rates of regional failure in Stages T1,T2,T3,and T4 patients were 0%,3.08%,0%,and 0%(P>0.05),respectively.The rates of regional failure in the patients without and with local failure were 1.03% and 0% (P>0.05).The 1-year and 3-year OS of upper-neck group were 97.7% and 94.2%,and those of whole-neck group were 97.4% and 91.9% (P=0.950).The 1-year and 3-year DFS of upper-neck group were 96.6% and 92.9%,and those of whole-neck group were 95.6% and 90.9% (P=0.730).Multivariate analysis showed that gender (P=0.039) and T stage (P=0.004) were independent prognosis factors of NO-NPC patients.Conclusions:Prophylactic irradiation to the upper neck doesn't influence the regional failure or long-term survival in Stage-NO NPC patients.Prophylactic irradiation to the upper neck (level Ⅱ,Ⅲ,ⅤA) is recommendable for Stage-NO NPC patients.The parapharyngeal space involvement,T stage,and the rates of local failure don't influence the regional failure in Stage-NO NPC patients.Gender and T stage were independent prognosis factors of Stage-NO NPC patients.