CAJ | 학술논문

目的：总结分析我院螺旋断层放疗治疗鼻咽癌36例失败病例的临床经验。方法2007年9月-2012年8月间共初治鼻咽癌217例，治疗失败36例(Ⅰ期1例、Ⅱ期5例、Ⅲ期16例、Ⅳ期14例)，其中单纯放疗9例，同步综合治疗27例。结果中位随访时间27(6~57)个月，中位失败时间12(3~42)个月，局部复发10例(Ⅰ期1例、Ⅱ期1例、Ⅲ期5例、Ⅳa期3例)，照射野内复发7例，照射野边缘复发3例；区域复发3例(Ⅲ期2例、Ⅳa期1例)，远处转移16例(Ⅱ期3例、Ⅲ期7例、Ⅳa期6例)，5例骨转移，5例肝转移，1例髓内转移，5例多器官转移；其他因素失败7例。死亡29例(80.6%)，包括局部复发7例，区域复发2例，远处转移13例，不明原因咽部出血5例，急性脑疝1例，全身虚弱衰竭1例。结论螺旋断层放疗治疗鼻咽癌失败主要原因为复发及转移，建议原发肿瘤GTV外扩5 mm边界并每日行图像引导；针对N1的Ⅱ期患者放疗联合含铂化疗可以有效降低治疗失败率；治疗失败后患者可从挽救治疗中获益。
목적：총결분석아원라선단층방료치료비인암36례실패병례적림상경험。방법2007년9월-2012년8월간공초치비인암217례，치료실패36례(Ⅰ기1례、Ⅱ기5례、Ⅲ기16례、Ⅳ기14례)，기중단순방료9례，동보종합치료27례。결과중위수방시간27(6~57)개월，중위실패시간12(3~42)개월，국부복발10례(Ⅰ기1례、Ⅱ기1례、Ⅲ기5례、Ⅳa기3례)，조사야내복발7례，조사야변연복발3례；구역복발3례(Ⅲ기2례、Ⅳa기1례)，원처전이16례(Ⅱ기3례、Ⅲ기7례、Ⅳa기6례)，5례골전이，5례간전이，1례수내전이，5례다기관전이；기타인소실패7례。사망29례(80.6%)，포괄국부복발7례，구역복발2례，원처전이13례，불명원인인부출혈5례，급성뇌산1례，전신허약쇠갈1례。결론라선단층방료치료비인암실패주요원인위복발급전이，건의원발종류GTV외확5 mm변계병매일행도상인도；침대N1적Ⅱ기환자방료연합함박화료가이유효강저치료실패솔；치료실패후환자가종만구치료중획익。
Objective To analyze the failure of helical tomotherapy (TOMO) in treatment of 36 patients with nasopharyngeal carcinoma (NPC). Methods Of the 217 NPC patients admitted to our hospital from September 2007 to August 2012, 36 failed to helical TOMO (including 1 at stageⅠ, 5 at stageⅡ, 16 at stageⅢ, and 14 at stageⅣ). Of these 36 patients, 9 received simple radiotherapy and 27 received synchronization radiotherapy. Results The median follow-up time was 27 months (6-57 months). The median failure time was 12 months (3-42 months). Of the 10 patients with local recurrence (including 1 at stageⅠ, 1 at stageⅡ, 5 at stageⅢ, and 3 at stageⅣa), 7 had recurrence in the irradiation field and 3 had recurrence in the irradiation field margin. Three patients had regional recurrence (including 2 at stage Ⅲand 1 at stageⅣa). Of the 16 patients with distant metastases (including 3 at stageⅡ, 7 at stageⅢ, and 6 at stageⅣa), 5 had bone metastasis, 5 had liver metastasis, 1 had intramedullary metastasis and 5 had multiple organ metastasis. Seven patients failed to the treatment due to other reasons. Twenty-nine patients died with a death rate of 80.6%. Of these 29 patients, 7 died of local recurrence, 2 died of regional recurrence, 13 died of distant metastasis, 5 died of pharyngeal bleeding with unknown reasons, 1 died of cerebral hernia, and 1 died of systematic failure. Conclusion Recurrence and metastasis are the main reasons for the failure of helical TOMO in treatment of NPC patients. Extension of 5 mm margin of GTV under image guidance is suggested for primary NPC. Radiotherapy in combination with platinum chemotherapy can reduce the failure rate in NPC patients at stageⅡwho fail to helical TOMO.