CAJ | 학술논문

目的：探讨儿童及青少年鼻咽癌的临床特点、治疗、预后及并发症。方法回顾性分析53例儿童及青少年（≤20岁）鼻咽癌患者的临床资料。结果首发症状以颈部肿块和鼻部症状（血涕、鼻塞）最多见，分别占60.4％和20.7％，多数被误诊为颈部淋巴结炎、淋巴结结核、鼻炎、中耳炎。53例均为首次放射治疗，其中有7例因鼻咽部和颈部复发及3例颈部复发者行第二次放射治疗，照射剂量鼻咽部57～69 gy，颈部60～75 gy，常规分割外照射。22例配合化疗（ PBF或PFA方案3～5周期）。放疗后鼻咽部和颈部均有复发7例，单纯颈部复发3例。5年生存率73.6％（39/53）， II期5年生存率88.2％（15/17），III期及IV期66.7％（24/36）。远地转移11例（占20.8％），其中肺转移3例、全身多处骨转移6例、肝转移2例（均存活不满5年）。放射治疗后遗症主要为龋齿18.0％、颈部软组织纤维化18.0％、记忆力下降13.6％、听力下降9.0％、生长发育迟缓9.0％、张口困难4.5％、语音不清4.5％等。结论儿童及青少年鼻咽癌患者具有发病率低、病期偏晚、预后较好的特点。放射治疗效果较好，早期放射反应出现的比例高、时间早。治疗失败出现远处转移后，继续予以相应的治疗，仍可取的较好的疗效。
목적：탐토인동급청소년비인암적림상특점、치료、예후급병발증。방법회고성분석53례인동급청소년（≤20세）비인암환자적림상자료。결과수발증상이경부종괴화비부증상（혈체、비새）최다견，분별점60.4％화20.7％，다수피오진위경부림파결염、림파결결핵、비염、중이염。53례균위수차방사치료，기중유7례인비인부화경부복발급3례경부복발자행제이차방사치료，조사제량비인부57～69 gy，경부60～75 gy，상규분할외조사。22례배합화료（ PBF혹PFA방안3～5주기）。방료후비인부화경부균유복발7례，단순경부복발3례。5년생존솔73.6％（39/53）， II기5년생존솔88.2％（15/17），III기급IV기66.7％（24/36）。원지전이11례（점20.8％），기중폐전이3례、전신다처골전이6례、간전이2례（균존활불만5년）。방사치료후유증주요위우치18.0％、경부연조직섬유화18.0％、기억력하강13.6％、은력하강9.0％、생장발육지완9.0％、장구곤난4.5％、어음불청4.5％등。결론인동급청소년비인암환자구유발병솔저、병기편만、예후교호적특점。방사치료효과교호，조기방사반응출현적비례고、시간조。치료실패출현원처전이후，계속여이상응적치료，잉가취적교호적료효。
Objective To investigate the clinical characteristics , treatment , prognosis and complications of nasopharyngeal carcinoma in children and adolescents .Methods Clinical data of 53 children and adolescents (≤20 years) with nasopharyngeal car-cinoma were retrospectively analyzed .Results The most common first symptoms were neck mass and nasal symptoms ( blood tears and nasal congestion ) that accounted for 60.4%and 20.7%, respectively .The majority of patients were misdiagnosed as cervical lymphad-enitis, lymph node tuberculosis, rhinitis or otitis media.All the patients had the first radiotherapy .There were 7 cases of the nasophar-ynx and neck recurrence and 3 cases of recurrence undergoing a second neck radiotherapy .The radiation doses were nasopharynx 57 ~69 gy and neck 60 ~75 gy with conventional split external irradiation .There were 22 cases combining with chemotherapy ( PBF or PFA program from 3 to 5 cycles).There were 7 cases having nasopharynx and neck recurrence and 3 cases having simple neck recurrence af-ter radiotherapy .The average 5-year survival rate was 73.6%, stage II 88.2%and stage III/IV 66.7%.Distant metastasis was found in 11 patients (20.8%), including lung metastases in 3 cases, systemic multiple bone metastases in 6 cases and liver metastases in 2 cases.Their mean survivals were less than 5 years.Radiotherapy sequelas included dental caries (18.0%), neck soft tissue fibrosis (18.0%), memory loss (13.6%), hearing loss (9.0%), growth retardation (9.0%), trismus (4.5%) or unclear voice (4.5%).Conclusion Children and adolescents with nasopharyngeal carcinoma have characteristics of low incidence , later stage of disease and better prognosis .Radiation therapy has a good effect and a high percentage of early radiation reactions .Distant metastasis could happen if treatment was failure .A better outcome could be obtained if further appropriate treatment is taken .