中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2012年
5期
407-411
,共5页
吴芳%王仁生%冯国生%李桂生%刘美莲%严浩林%朱锦贤%张勇%胡凯
吳芳%王仁生%馮國生%李桂生%劉美蓮%嚴浩林%硃錦賢%張勇%鬍凱
오방%왕인생%풍국생%리계생%류미련%엄호림%주금현%장용%호개
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%Prognosis
目的 观察调强放疗(IMRT)初治鼻咽癌的临床疗效及不良反应,并分析影响预后的因素.方法 2006-2008年,6个治疗中心共300例经病理活检确诊为鼻咽癌的初治患者接受全程IMRT.UICC/AJCC 2002分期Ⅰ、Ⅱ、Ⅲ、Ⅳa+b期分别为6、45、141、108例.放疗处方剂量鼻咽原发灶计划把体积为70 ～ 74 Gy,颈部转移淋巴结计划把体积为68 ～70 Gy,计划靶体积-1为60 ～ 64 Gy,计划靶体积-2为50～ 54 Gy,均分30次6周完成.Ⅲ～Ⅳa+b期患者接受了以铂类为基础化疗.Cox法多因素预后分析.结果 随访率为99.7％.4年局部控制率、区域控制率、无远处转移率、无瘤生存率及总生存率分别为94.0％、95.5％、87.4％、80.8％及86.1％.急性1、2、3级放射性黏膜炎分别占18.0％ 、48.7％、33.3％,晚期0、1、2级口干分别占12.0％、75.7％ 、12.3％.18、15、42例出现局部、颈部淋巴结复发、远处转移.多因素分析显示N分期影响总生存率(x2=5.17,P=0.023)、无远处转移率(x2 =6.91,P=0.009)、无瘤生存率(x2=8.15,P=0.004).结论 IMRT可提高初治鼻咽癌患者临床疗效,不良反应可耐受,治疗失败最主要原因为远处转移,N分期是影响预后的主要因素.
目的 觀察調彊放療(IMRT)初治鼻嚥癌的臨床療效及不良反應,併分析影響預後的因素.方法 2006-2008年,6箇治療中心共300例經病理活檢確診為鼻嚥癌的初治患者接受全程IMRT.UICC/AJCC 2002分期Ⅰ、Ⅱ、Ⅲ、Ⅳa+b期分彆為6、45、141、108例.放療處方劑量鼻嚥原髮竈計劃把體積為70 ～ 74 Gy,頸部轉移淋巴結計劃把體積為68 ～70 Gy,計劃靶體積-1為60 ～ 64 Gy,計劃靶體積-2為50～ 54 Gy,均分30次6週完成.Ⅲ～Ⅳa+b期患者接受瞭以鉑類為基礎化療.Cox法多因素預後分析.結果 隨訪率為99.7％.4年跼部控製率、區域控製率、無遠處轉移率、無瘤生存率及總生存率分彆為94.0％、95.5％、87.4％、80.8％及86.1％.急性1、2、3級放射性黏膜炎分彆佔18.0％ 、48.7％、33.3％,晚期0、1、2級口榦分彆佔12.0％、75.7％ 、12.3％.18、15、42例齣現跼部、頸部淋巴結複髮、遠處轉移.多因素分析顯示N分期影響總生存率(x2=5.17,P=0.023)、無遠處轉移率(x2 =6.91,P=0.009)、無瘤生存率(x2=8.15,P=0.004).結論 IMRT可提高初治鼻嚥癌患者臨床療效,不良反應可耐受,治療失敗最主要原因為遠處轉移,N分期是影響預後的主要因素.
목적 관찰조강방료(IMRT)초치비인암적림상료효급불량반응,병분석영향예후적인소.방법 2006-2008년,6개치료중심공300례경병리활검학진위비인암적초치환자접수전정IMRT.UICC/AJCC 2002분기Ⅰ、Ⅱ、Ⅲ、Ⅳa+b기분별위6、45、141、108례.방료처방제량비인원발조계화파체적위70 ～ 74 Gy,경부전이림파결계화파체적위68 ～70 Gy,계화파체적-1위60 ～ 64 Gy,계화파체적-2위50～ 54 Gy,균분30차6주완성.Ⅲ～Ⅳa+b기환자접수료이박류위기출화료.Cox법다인소예후분석.결과 수방솔위99.7％.4년국부공제솔、구역공제솔、무원처전이솔、무류생존솔급총생존솔분별위94.0％、95.5％、87.4％、80.8％급86.1％.급성1、2、3급방사성점막염분별점18.0％ 、48.7％、33.3％,만기0、1、2급구간분별점12.0％、75.7％ 、12.3％.18、15、42례출현국부、경부림파결복발、원처전이.다인소분석현시N분기영향총생존솔(x2=5.17,P=0.023)、무원처전이솔(x2 =6.91,P=0.009)、무류생존솔(x2=8.15,P=0.004).결론 IMRT가제고초치비인암환자림상료효,불량반응가내수,치료실패최주요원인위원처전이,N분기시영향예후적주요인소.
Objective To evaluate the treatment efficacy,toxicities and prognostic factors of nasopharyngeal carcinoma ( NPC ) treated with intensity modulated radiation oncology ( IMRT ).Methods Between January 2006 and August 2008,300 patients with pathologically diagnosed NPC from 6 center received IMRT.The number of patients with stage Ⅰ,Ⅱ,Ⅲ and Ⅳa+b disease (UICC/AJCC 2002 staging system) were 6,45,141 and 108,respectively.The prescription doses were as follows:70-74 Gy/30f toplanning target volume of primary nasopharynx tumor ( PTVRλ),68-70 Gy/30f to planning target volume of positive lymphnode (ptvnd),60-64 Gy/30f to higher risk region (PTV1),50-54 Gy/30f to lower risk region (PTV2).Patients with stage Ⅲ and Ⅳa+b disease also received cisplatin-based chemotherapy.Cox method was used for Multivariate analysis.Results The follow-up rate was 99.7％.The 4-year rate of local control,regional control,metastasis-free survival (DMFS),disease-free survival (DFS) and overall survival (OS) was 94.0％,95.5％,87.4％,80.8％,86.1％,respectively.Mucositis was the most severe acute toxicity,with 18.0％ grade 1,48.7％ grade 2,33.3％ grade 3.No patient suffered from grade 4mucositis.Xerostomia was the most common late toxicity,with 12.0％ grade 0,75.7％ grade 1,12.3％grade 2.No grade 3-4 xerostomia was observed.There were 18,15 and 42 patients failed in local,regional and distant metastasis,respectively.Multivariate analysis showed that N stage was the only prognostic factor for OS (x2 =5.17,P=0.023),DMFS (x2 =6.91,P=0.009) and DFS (x2 =8.15,P=0.004) in these patients.Conclusions IMRT can improve the treatment efficacy of NPC.The acute and late toxicities were tolerated.Distant metastasis becomes the main treatment failure.N stage is a significant prognostic factors.
