中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2013年
1期
42-45
,共4页
肖光莉%王卫华%丘熹彬%曹亚兵%王余锋
肖光莉%王衛華%丘熹彬%曹亞兵%王餘鋒
초광리%왕위화%구희빈%조아병%왕여봉
鼻咽肿瘤/放射疗法%放射疗法,调强%不良反应
鼻嚥腫瘤/放射療法%放射療法,調彊%不良反應
비인종류/방사요법%방사요법,조강%불량반응
Nasopharyngeal neoplasms/radiotherapy%Radiotherapy,intensity-modulated%Adverse effects
目的 了解鼻咽癌调强放疗的晚期不良反应并分析危险因素.方法 共299例鼻咽癌首程接受调强放疗,鼻咽及颈部肿瘤处方剂量为70 Gy,亚临床区域剂量为60 Gy,下颈部及锁骨上区预防剂量为54 Gy,5次/周共30次.分析本院随访的176例患者资料.危险因素行Logistic法分析.结果 中位随访时间为52个月,随访率为99.7％.最常见不良反应为口腔干燥、听力下降,发生率分别为54.5％、61.4％.0～1级皮肤、皮下或鼻咽黏膜发生率分别为91.5％、93.2％或97.2％.1～2级张口困难发生率为3.4％.严重治疗并发症包括5例颅神经损伤,2例鼻咽出血(其中1例因鼻咽大出血而死亡).影响口干、听力下降危险因素有化疗(x2=7.38、7.96,P=0.007、0.005)和腮腺中位剂量、内耳中位剂量(x2 =4.09、7.96,P=0.043、0.005).结论 鼻咽癌调强放疗后大多数只有轻度皮肤、皮下及鼻咽黏膜组织不良反应；除早期病变外,由于放疗剂量和化疗因素使口干、听力下降发生率仍较高.
目的 瞭解鼻嚥癌調彊放療的晚期不良反應併分析危險因素.方法 共299例鼻嚥癌首程接受調彊放療,鼻嚥及頸部腫瘤處方劑量為70 Gy,亞臨床區域劑量為60 Gy,下頸部及鎖骨上區預防劑量為54 Gy,5次/週共30次.分析本院隨訪的176例患者資料.危險因素行Logistic法分析.結果 中位隨訪時間為52箇月,隨訪率為99.7％.最常見不良反應為口腔榦燥、聽力下降,髮生率分彆為54.5％、61.4％.0～1級皮膚、皮下或鼻嚥黏膜髮生率分彆為91.5％、93.2％或97.2％.1～2級張口睏難髮生率為3.4％.嚴重治療併髮癥包括5例顱神經損傷,2例鼻嚥齣血(其中1例因鼻嚥大齣血而死亡).影響口榦、聽力下降危險因素有化療(x2=7.38、7.96,P=0.007、0.005)和腮腺中位劑量、內耳中位劑量(x2 =4.09、7.96,P=0.043、0.005).結論 鼻嚥癌調彊放療後大多數隻有輕度皮膚、皮下及鼻嚥黏膜組織不良反應；除早期病變外,由于放療劑量和化療因素使口榦、聽力下降髮生率仍較高.
목적 료해비인암조강방료적만기불량반응병분석위험인소.방법 공299례비인암수정접수조강방료,비인급경부종류처방제량위70 Gy,아림상구역제량위60 Gy,하경부급쇄골상구예방제량위54 Gy,5차/주공30차.분석본원수방적176례환자자료.위험인소행Logistic법분석.결과 중위수방시간위52개월,수방솔위99.7％.최상견불량반응위구강간조、은력하강,발생솔분별위54.5％、61.4％.0～1급피부、피하혹비인점막발생솔분별위91.5％、93.2％혹97.2％.1～2급장구곤난발생솔위3.4％.엄중치료병발증포괄5례로신경손상,2례비인출혈(기중1례인비인대출혈이사망).영향구간、은력하강위험인소유화료(x2=7.38、7.96,P=0.007、0.005)화시선중위제량、내이중위제량(x2 =4.09、7.96,P=0.043、0.005).결론 비인암조강방료후대다수지유경도피부、피하급비인점막조직불량반응；제조기병변외,유우방료제량화화료인소사구간、은력하강발생솔잉교고.
Objective To investigate the late toxicities after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma and analyze the risk factors for treatment complications.Methods A total of 299 patients with nasopharyngeal carcinoma were given initial IMRT.The nasopharyngeal lesion and cervical lymph nodes were given a prescribed dose of 70 Gy ; the dose was 60 Gy to subclinical region ; the prophylactic dose was 54 Gy to the lower neck and supraclavicular region;these doses were given in 30 fractions over 6 weeks.The clinical records of 176 patients followed up were analyzed.The hazard factors were analyzed with Logistic method.Results The median follow-up was 52 months,and the follow-up rate was 99.7％.The most common radiotherapy-induced toxicities were xerostomia and hearing loss,with incidence rates of 54.5％ and 61.4％.The incidences rate of grade 0-1 adverse reaction of skin,subcutaneous tissue,or nasopharyngeal mucosa was 91.5 ％,93.2％,or 97.2％ ;the incidence rate of grade 1-2 trismus was 3.4％.Severe complications included cranial nerve injury (5 patients) and epistaxis (2 patients,one dying due to profuse epistaxis).The hazard factors for xerostomia and hearing loss were chemotherapy (x2 =7.38,P =0.007 ; x2 =7.96,P =0.005) and median doses to the parotid gland and inner ear (x2 =4.09,P =0.043 ; x2 =7.96,P =0.005).Conclusions Most patients develop only mild toxicity of the skin,subcutaneous tissue,or nasopharyngeal mucosa after IMRT.The incidence rates of xerostomia and hearing loss remain high owing to radiotherapy dosage and chemotherapy.
