中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2010年
3期
191-196
,共6页
赵充%肖巍魏%韩非%卢丽霞%吴少雄%陈建洲%林承光%黄劭敏%邓小武%卢泰祥%崔念基
趙充%肖巍魏%韓非%盧麗霞%吳少雄%陳建洲%林承光%黃劭敏%鄧小武%盧泰祥%崔唸基
조충%초외위%한비%로려하%오소웅%진건주%림승광%황소민%산소무%로태상%최념기
鼻咽肿瘤/放射疗法%放射疗法,调强%预后分析
鼻嚥腫瘤/放射療法%放射療法,調彊%預後分析
비인종류/방사요법%방사요법,조강%예후분석
Nasopharyngeal neoplasms/radiotherapy%Radiotherapy,intensity modulated%Prognostic analysis
目的 报道初治鼻咽癌调强放疗(IMRT)的长期随访结果并分析影响预后的因素.方法 419例初治鼻咽癌接受全程IMRT.UICC/AJCC2002分期Ⅰ、Ⅱ、Ⅲ和Ⅳ期分别为28、113、202和76例.182例单纯放疗,237例放化疗.放疗处方剂量:鼻咽大体肿瘤靶区66～70 Gy分25～30次,颈部淋巴结大体肿瘤靶区60～64 Gy分25～30次,临床靶区155～62 Gy分25～30次,临床靶区242～54 Gy分25～30次.结果 随访6～94个月,随访满5年患者166例.局部复发21例,区域复发13例,远处转移57例.5年局部控制率、区域控制率和无远处转移率分别为92.7%、95.8%和85.5%.5年无瘤生存率(DFS)、疾病特异生存率(DSS)和总生存率分别为76.3%、84.4%和83.3%.单因素分析显示T早期、疗前原发肿瘤体积≤20 cm~3、N早期、疗前颈淋巴结体积≤5 cm~3患者5年DFS和DSS优于各自对应项[84.1%:67.6%(χ~2=12.16,P:0.000)和92.1%:75.1%(χ~2=14.86,P=0.000);89.1%:62.9%(χ~2=14.13,P=0.000)和96.2%:72.1%,(χ~2=38.76,P=0.000);81.1%:64.5%(χ~2=15.49,P=0.000)和87.8%:76.1%(χ~2=10.89,P=0.001);83.3%:68.8%(χ~2=14.13,P=0.000)和90.0%:78.1%(χ~2=10.71,P=0.001)].多因素分析显示疗前原发肿瘤体积、N分期是DFS和DSS的独立预后因素(χ~2=26.81,P=0.000,χ~2=4.92,P=0.026和χ~2=28.47,P=0.000,χ~2=9.50,P=0.002).全组未观察到4级急性和晚期副反应;随访满3年以上的243例患者中,3级晚期毒副反应发生率仅为2.8%.结论 IMRT±化疗提高了初治鼻咽癌的长期疗效,尤其提高了局部和区域控制率.远处转移已成为治疗失败的最主要原因.疗前原发肿瘤体积和N分期是影响生存的主要因素.IMRT±化疗的急性副反应可耐受,晚期副反应轻微.
目的 報道初治鼻嚥癌調彊放療(IMRT)的長期隨訪結果併分析影響預後的因素.方法 419例初治鼻嚥癌接受全程IMRT.UICC/AJCC2002分期Ⅰ、Ⅱ、Ⅲ和Ⅳ期分彆為28、113、202和76例.182例單純放療,237例放化療.放療處方劑量:鼻嚥大體腫瘤靶區66～70 Gy分25～30次,頸部淋巴結大體腫瘤靶區60～64 Gy分25～30次,臨床靶區155～62 Gy分25～30次,臨床靶區242～54 Gy分25～30次.結果 隨訪6～94箇月,隨訪滿5年患者166例.跼部複髮21例,區域複髮13例,遠處轉移57例.5年跼部控製率、區域控製率和無遠處轉移率分彆為92.7%、95.8%和85.5%.5年無瘤生存率(DFS)、疾病特異生存率(DSS)和總生存率分彆為76.3%、84.4%和83.3%.單因素分析顯示T早期、療前原髮腫瘤體積≤20 cm~3、N早期、療前頸淋巴結體積≤5 cm~3患者5年DFS和DSS優于各自對應項[84.1%:67.6%(χ~2=12.16,P:0.000)和92.1%:75.1%(χ~2=14.86,P=0.000);89.1%:62.9%(χ~2=14.13,P=0.000)和96.2%:72.1%,(χ~2=38.76,P=0.000);81.1%:64.5%(χ~2=15.49,P=0.000)和87.8%:76.1%(χ~2=10.89,P=0.001);83.3%:68.8%(χ~2=14.13,P=0.000)和90.0%:78.1%(χ~2=10.71,P=0.001)].多因素分析顯示療前原髮腫瘤體積、N分期是DFS和DSS的獨立預後因素(χ~2=26.81,P=0.000,χ~2=4.92,P=0.026和χ~2=28.47,P=0.000,χ~2=9.50,P=0.002).全組未觀察到4級急性和晚期副反應;隨訪滿3年以上的243例患者中,3級晚期毒副反應髮生率僅為2.8%.結論 IMRT±化療提高瞭初治鼻嚥癌的長期療效,尤其提高瞭跼部和區域控製率.遠處轉移已成為治療失敗的最主要原因.療前原髮腫瘤體積和N分期是影響生存的主要因素.IMRT±化療的急性副反應可耐受,晚期副反應輕微.
목적 보도초치비인암조강방료(IMRT)적장기수방결과병분석영향예후적인소.방법 419례초치비인암접수전정IMRT.UICC/AJCC2002분기Ⅰ、Ⅱ、Ⅲ화Ⅳ기분별위28、113、202화76례.182례단순방료,237례방화료.방료처방제량:비인대체종류파구66～70 Gy분25～30차,경부림파결대체종류파구60～64 Gy분25～30차,림상파구155～62 Gy분25～30차,림상파구242～54 Gy분25～30차.결과 수방6～94개월,수방만5년환자166례.국부복발21례,구역복발13례,원처전이57례.5년국부공제솔、구역공제솔화무원처전이솔분별위92.7%、95.8%화85.5%.5년무류생존솔(DFS)、질병특이생존솔(DSS)화총생존솔분별위76.3%、84.4%화83.3%.단인소분석현시T조기、료전원발종류체적≤20 cm~3、N조기、료전경림파결체적≤5 cm~3환자5년DFS화DSS우우각자대응항[84.1%:67.6%(χ~2=12.16,P:0.000)화92.1%:75.1%(χ~2=14.86,P=0.000);89.1%:62.9%(χ~2=14.13,P=0.000)화96.2%:72.1%,(χ~2=38.76,P=0.000);81.1%:64.5%(χ~2=15.49,P=0.000)화87.8%:76.1%(χ~2=10.89,P=0.001);83.3%:68.8%(χ~2=14.13,P=0.000)화90.0%:78.1%(χ~2=10.71,P=0.001)].다인소분석현시료전원발종류체적、N분기시DFS화DSS적독립예후인소(χ~2=26.81,P=0.000,χ~2=4.92,P=0.026화χ~2=28.47,P=0.000,χ~2=9.50,P=0.002).전조미관찰도4급급성화만기부반응;수방만3년이상적243례환자중,3급만기독부반응발생솔부위2.8%.결론 IMRT±화료제고료초치비인암적장기료효,우기제고료국부화구역공제솔.원처전이이성위치료실패적최주요원인.료전원발종류체적화N분기시영향생존적주요인소.IMRT±화료적급성부반응가내수,만기부반응경미.
Objective To investigate the long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy (IMRT). Methods From February 2001 to December 2006, 419 patients with nasopharyngeal carcinoma in Cancer Center of Sun yatsen University received IMRT. The number of patients with stage Ⅰ,Ⅱ,Ⅲ and Ⅳ disease was 28, 113, 202 and 76, respectively. In all, 182 and 237 patients received radiotherapy alone and chemoradiotherapy. The prescription doses were as follows:66-70 Gy/25 -30 f to GTV_(nx), 60 -64 Gy/25 -30 f to GTV_(nd), 55 -62 Gy/25 -30 f to CTV_1, and 42 -54 Gy/25 -30 f to CTV_2. Results The median follow-up time was 49 months (6 -94 months). The number of patients with follow-up of 1-, 3-, and 5-year were 419,360 and 166, respectively. Twenty-one, 13 and 57 patients had local recurrence, regional recurrence and distant metastasis, respectively. The 5-year local control (LC) rate, regional control (RC) rate and free from distant metastasis survival rate was 92.7%, 95.8% and 85.5%, respectively. The 5-year disease-free survival (DFS) and disease-specific survival (DSS) was 76. 3% and 84.4%, respectively. In univariate analysis, T stage, primary tumor volume, N stage and volume of cervical nodes before treatment were significant predictors of DFS and DSS, favoring the patients with early T stage (84. 1% vs. 67.6% ,Χ~2 = 12. 16, P = 0. 000 : 92. 1% vs. 75. 1% ,Χ~2 = 14. 86 . P = 0. 000) , primary tumor volume less than 20 cm~3 (89. 1% vs. 62. 9% ,Χ~2 =14. 13,P=0.000;96.2% vs. 72. 1% ,Χ~2 =38. 76,P=0.000), early N stage (81.1% vs. 64. 5%, Χ~2 = 15.49, P = 0. 000; 87. 8% vs. 76. 1%, Χ~2 = 10. 89, P = 0. 001) and volume of cervical nodes less than 5 cm~3 (83. 3% vs. 68. 8%, Χ~2 = 14. 13, P = 0. 000 ; 90. 0% vs. 78. 1%, Χ~2 = 10. 71 ,P =0. 001). Multivariate analysis showed that primary tumor volume (Χ~2 = 26. 81, P = 0. 000 and Χ~2 = 28. 47, P = 0. 000) and N stage (Χ~2 = 4. 92, P = 0. 026 and Χ~2 = 9.50, P = 0. 002) were independent predictive factors for both DFS and DSS. No grade 4 acute and late toxicities were observed. In 243 patients with follow-up time more than 3 years, only 2. 8% suffered from grade 3 late toxicifies. Conclusions IMRT with or without chemotherapy can improve the long-term survival of patients with nasopharyngeal carcinoma, especially in LC and RC. Distant metastasis becomes the main treatment failure. Primary tumor volume and N stage are significant prognostic factors. Acute and late toxicities are acceptable.
