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
6期
488-491
,共4页
鼻咽肿瘤/放射疗法%放射疗法,调强%放射疗法,常规%预后
鼻嚥腫瘤/放射療法%放射療法,調彊%放射療法,常規%預後
비인종류/방사요법%방사요법,조강%방사요법,상규%예후
Nasopharyngeal neoplasms/radiotherapy%Radiotherapy,intensity-modulated%Radiotherapy,convention%Prognosis
目的 评估鼻咽癌调强放疗的长期疗效,分析影响预后的因素.方法 回顾分析299例无远处转移鼻咽癌首程治疗病例资料.鼻咽原发灶及上颈部调强放疗70 Gy,下颈部及锁骨上区用单前野预防性常规放疗54 Gy,5次/周共30次.鼻咽残存灶采用局部小野IMRT加量或X刀补充照射4 ～ 20 Gy.用Kaplan-Meier方法计算总生存率(OS)、无疾病进展生存率(DPFS)、无远处转移生存率(DMFS)等,Logrank法检验和单因素预后分析,Cox法多因素预后分析.结果 全组随访率为99.7％,随访时间满5年者为119例.Ⅰ+Ⅱ、Ⅲ、Ⅳ期5年OS分别为97.1％、82.7％、52.2％(x2=46.19,P=0.000),DPFS分别为100％、77.6％、57.7％(x2=23.29,P=0.000),DMFS分别为100％、82.3％、63.7％(x2=16.57,P=0.000).男性和女性5年OS、DPFS、DMFS分别为70.7％和94.1％(x2=16.82,P =0.000)、71.5％和87.3％(x2=4.74,P=0.029)、77.2％和 89.7％(x2=4.38,P=0.036)；＜45岁男性和女性的分别为66.8％和91.2％(x2=7.07,P=0.008)、59.9％和91.2％ (x2=7.72,P=0.005)、66.4％和94.0％(x2=8.46,P=0.004),≥45岁的只有OS不同(72.2％和96.0％,x2=10.19,P=0.001).多因素分析显示性别、TNM分期、淋巴结包膜受侵均影响OS (x2=14.27、5.72、17.64,P=0.000、0.017、0.000)、DPFS (x2=5.33、15.70、10.57,P=0.021、0.000、0.001)、DMFS (x2=4.30、11.08、21.24,P=0.038、0.001、0.000),颅内受侵、锁骨上淋巴结转移影响OS(x2=13.32、5.38,P=0.000、0.020).结论 除分期、淋巴结包膜受侵影响预后外,性别也是影响预后因素之一,特别是＜ 45岁男性预后更差.
目的 評估鼻嚥癌調彊放療的長期療效,分析影響預後的因素.方法 迴顧分析299例無遠處轉移鼻嚥癌首程治療病例資料.鼻嚥原髮竈及上頸部調彊放療70 Gy,下頸部及鎖骨上區用單前野預防性常規放療54 Gy,5次/週共30次.鼻嚥殘存竈採用跼部小野IMRT加量或X刀補充照射4 ～ 20 Gy.用Kaplan-Meier方法計算總生存率(OS)、無疾病進展生存率(DPFS)、無遠處轉移生存率(DMFS)等,Logrank法檢驗和單因素預後分析,Cox法多因素預後分析.結果 全組隨訪率為99.7％,隨訪時間滿5年者為119例.Ⅰ+Ⅱ、Ⅲ、Ⅳ期5年OS分彆為97.1％、82.7％、52.2％(x2=46.19,P=0.000),DPFS分彆為100％、77.6％、57.7％(x2=23.29,P=0.000),DMFS分彆為100％、82.3％、63.7％(x2=16.57,P=0.000).男性和女性5年OS、DPFS、DMFS分彆為70.7％和94.1％(x2=16.82,P =0.000)、71.5％和87.3％(x2=4.74,P=0.029)、77.2％和 89.7％(x2=4.38,P=0.036)；＜45歲男性和女性的分彆為66.8％和91.2％(x2=7.07,P=0.008)、59.9％和91.2％ (x2=7.72,P=0.005)、66.4％和94.0％(x2=8.46,P=0.004),≥45歲的隻有OS不同(72.2％和96.0％,x2=10.19,P=0.001).多因素分析顯示性彆、TNM分期、淋巴結包膜受侵均影響OS (x2=14.27、5.72、17.64,P=0.000、0.017、0.000)、DPFS (x2=5.33、15.70、10.57,P=0.021、0.000、0.001)、DMFS (x2=4.30、11.08、21.24,P=0.038、0.001、0.000),顱內受侵、鎖骨上淋巴結轉移影響OS(x2=13.32、5.38,P=0.000、0.020).結論 除分期、淋巴結包膜受侵影響預後外,性彆也是影響預後因素之一,特彆是＜ 45歲男性預後更差.
목적 평고비인암조강방료적장기료효,분석영향예후적인소.방법 회고분석299례무원처전이비인암수정치료병례자료.비인원발조급상경부조강방료70 Gy,하경부급쇄골상구용단전야예방성상규방료54 Gy,5차/주공30차.비인잔존조채용국부소야IMRT가량혹X도보충조사4 ～ 20 Gy.용Kaplan-Meier방법계산총생존솔(OS)、무질병진전생존솔(DPFS)、무원처전이생존솔(DMFS)등,Logrank법검험화단인소예후분석,Cox법다인소예후분석.결과 전조수방솔위99.7％,수방시간만5년자위119례.Ⅰ+Ⅱ、Ⅲ、Ⅳ기5년OS분별위97.1％、82.7％、52.2％(x2=46.19,P=0.000),DPFS분별위100％、77.6％、57.7％(x2=23.29,P=0.000),DMFS분별위100％、82.3％、63.7％(x2=16.57,P=0.000).남성화녀성5년OS、DPFS、DMFS분별위70.7％화94.1％(x2=16.82,P =0.000)、71.5％화87.3％(x2=4.74,P=0.029)、77.2％화 89.7％(x2=4.38,P=0.036)；＜45세남성화녀성적분별위66.8％화91.2％(x2=7.07,P=0.008)、59.9％화91.2％ (x2=7.72,P=0.005)、66.4％화94.0％(x2=8.46,P=0.004),≥45세적지유OS불동(72.2％화96.0％,x2=10.19,P=0.001).다인소분석현시성별、TNM분기、림파결포막수침균영향OS (x2=14.27、5.72、17.64,P=0.000、0.017、0.000)、DPFS (x2=5.33、15.70、10.57,P=0.021、0.000、0.001)、DMFS (x2=4.30、11.08、21.24,P=0.038、0.001、0.000),로내수침、쇄골상림파결전이영향OS(x2=13.32、5.38,P=0.000、0.020).결론 제분기、림파결포막수침영향예후외,성별야시영향예후인소지일,특별시＜ 45세남성예후경차.
Objective To study long-term outcome and prognostic factors of nasopharyngeal carcinoma treated by intensity modulated radiotherapy.Methods A total of 299 patients with nondisseminated nasopharyngeal carcinoma who received initial radiotherapy were analyzed retrospectively.The primary lesion and the upper neck received 70 Gy (5 fraction per week in all 30 fraction) by intensitymodulated radiotherapy (IMRT).The lower neck and the supraclavicular fossa was given 54 Gy (5 fraction per week in all 30 fraction) by a single anterior tangent field with spinal cord block.A median dose of 9.2 Gy (4-20.Gy) was given to the residual primary lesion by IMRT or X-knife.The Kaplan-Meier method was used for calculating the overall survival (OS),disease progression-free survival (DPFS),distant metastasisfree survival (DMFS),Log-rank test was used for evaluating the differences between groups.Multivariate prognostic factor was analyzcd by Cox method.Results The follow-up rate was 99.7％.119 patients were followed-up more than with 5 years.The 5-year OS for stage Ⅰ + Ⅱ,stage Ⅲ and stage Ⅳ were 97.1％,82.7％ and 52.2％(x2=46.19,P=0.000),the 5 years DPFS were 100％,77.6％ and 57.7％ (x2=23.29,P =0.000),DMFS were 100％,82.3％,63.7％ (x2 =16.57,P =0.000) respectively.The 5 year OS,DPFS and DMFS of male and female were 70.7％ vs 94.1％ (x2=16.82,P=0.000),71.5％ vs 87.3％ (x2 =4.74,P =0.029) and 77.2％ vs 89.7％ (x2 =4.38,P =0.036) respectively.For patients who were younger than 45-years,the male had a significantly unfavorable 5-year OS (66.8％ vs.91.2％,x2=7.07,P=0.008),DPFS (59.9％ vs.91.2％,x2=7.72,P=0.005) and DMFS (66.4％ vs.94.0％,x2 =8.46,P =0.004) ;For patients who were old than 45-years,only OS was significantly different between male and female (72.2％ vs.96.0％,x2 =10.19,P =0.001).Multivariate analysis showed the independent prognosticfactors for OS,DPFS,DMFS,were gender (x2 =14.27,5.72,17.64,P =0.000,0.017,0.000),TNM stage (x2 =5.33,15.70,10.57,P =0.021,0.000,0.001) and lymph nodes capsular invasion (x2 =4.30,11.08,21.24,P =0.038,0.001,0.000).Intracranial invasion and supraclavicular lymph node metastasis were independent prognostic factors for OS (x2 =13.32,5.38,P =O.000,0.020).Conclusions The TNM stage,lymph nodes capsular invasion and gender are independent prognostic factors for nasopharyngeal carcinoma treated by intensity-modulated radiotherapy.The patients of younger than 45years own a worse outcome.
