CAJ | 학술논문

目的比较颈椎受侵局部晚期鼻咽癌患者使用调强放疗(IMRT)和常规放疗的临床疗效及不良反应.方法收集2006年1月至2012年12月颈椎受侵无远处转移的初治鼻咽癌患者53例,其中调强放疗24例,肿瘤靶区剂量72 ～74 Gy/33次.常规放疗29例,靶区剂量68 ～74 Gy/34 ～37次.全部患者接受顺铂+氟尿嘧啶方案的同步化疗及放疗后4～6周期的辅助化疗.结果调强组和常规组3年总生存率为87.7％和65.5％,5年总生存率为45.5％和9.1％(x2 =6.89,P＜0.05);两组间的局部无进展3年生存率分别为87.4％和69.9％,5年生存率为49.4％和9.4％(x2=13.26,P＜0.05).但两组间的无远处转移3年生存率为94.4％和40.8％,5年生存率为79.8％和30.4％,差异无统计学意义.N分期(x2=8.53,P＜0.05)和调强放疗(x2=8.02,P＜0.05)为患者总生存率及无进展生存率的相关因素.调强组放疗后口干的发生率显著低于常规组(Z=-2.67,P＜0.05),两组患者急性口咽黏膜炎和骨髓不良反应的发生率差异无统计学意义.结论与常规放疗相比,颈椎受侵局部晚期鼻咽癌患者行调强放疗能明显提高局部控制率和总生存率,但未能降低远处转移率;同时,调强放疗可以降低口干等不良反应发生率.
목적 비교경추수침국부만기비인암환자사용조강방료(IMRT)화상규방료적림상료효급불량반응.방법 수집2006년1월지2012년12월경추수침무원처전이적초치비인암환자53례,기중조강방료24례,종류파구제량72 ～74 Gy/33차.상규방료29례,파구제량68 ～74 Gy/34 ～37차.전부환자접수순박+불뇨밀정방안적동보화료급방료후4～6주기적보조화료.결과 조강조화상규조3년총생존솔위87.7％화65.5％,5년총생존솔위45.5％화9.1％(x2 =6.89,P＜0.05);량조간적국부무진전3년생존솔분별위87.4％화69.9％,5년생존솔위49.4％화9.4％(x2=13.26,P＜0.05).단량조간적무원처전이3년생존솔위94.4％화40.8％,5년생존솔위79.8％화30.4％,차이무통계학의의.N분기(x2=8.53,P＜0.05)화조강방료(x2=8.02,P＜0.05)위환자총생존솔급무진전생존솔적상관인소.조강조방료후구간적발생솔현저저우상규조(Z=-2.67,P＜0.05),량조환자급성구인점막염화골수불량반응적발생솔차이무통계학의의.결론 여상규방료상비,경추수침국부만기비인암환자행조강방료능명현제고국부공제솔화총생존솔,단미능강저원처전이솔;동시,조강방료가이강저구간등불량반응발생솔.
Objective To compare the efficacy and side-effects of intensity-modulated radiotherapy (IMRT) and conventional radiotherapy in treatment of nasopharyngeal carcinoma (NPC) involving cervical vertebrae.Methods Twenty-four patients of NPC with cervical vertebra involvement underwent IMRT with the dose to tumor target of 72-74 Gy divided into 33 fractions (IMRT group),and 29 patients underwent conventional radiotherapy with the total dose to tumor target of 68-74 Gy/34-37 fractions (2D-CRT group).All the 53 cases accepted platinum-based concurrent chemotherapy of cisplatin plus fluorouracil and 4-6 cycles of adjuvant chemotherapy after the radiotherapy.Follow-up was conducted for 6 months to more than 7 years.Results The 3-and 5-year overall survival (OS) rates of the IMRT group were 87.7％ and 65.5％ respectively,both significantly higher than those of the 2D-CRT group (45.5％ and 9.1％ respectively,x2 =6.89,P ＜ 0.05),and the 3-and 5-year local progression-free survival (LPFS) rates of the IMRT group were 87.4％ and 49.4％ respectively,both significantly higher than those of the 2D-CRT group (69.9％ and 9.4％ respectively,x2 =13.26,P ＜0.05),and there were no significant statistical differences in the 3-,and 5-year distant metastasis-free survival (DMFS) rates (94.4％ vs 40.8％ and 79.8％ vs 30.4％ respectively,x2 =2.29,P ＞ 0.05) between two groups.Analysis showed N stage (x2 =8.53,P ＜ 0.05) and radiotherapy protocol (x2 =8.02,P ＜ 0.05) as the independent prognostic factors for OS and LPFS.The incidence of grade 2 and 3 xerostomia of the IMRT group was 29.17％,significantly lower than that of the 2D-CRT group (65.52％,x2 =7.11,P ＜0.05).Whereas,there were no significant statistical differences between these 2 groups in the incidence rates of acute irradiation mucositis and bone marrow suppression.Conclusions IMRT improves the local progression-free survival and overall survival and reduces the incidence of grade 2 and 3 radiation-induced xerostomia in local advanced NPC with cervical vertebra involvement more effectively than conventional radiotherapy.However,it fails to reduce the incidence of distant metastasis.