CAJ | 학술논문

背景与目的:目前复发鼻咽癌诊治困难,本研究通过前瞻性研究应用调强适形放疗(intensity-modulated? radiation? therapy,IMRT)治疗复发性鼻咽癌,评价疗效及不良反应,并进行相关临床预后因素分析.方法:将2006年6月—2010年9月经复旦大学附属肿瘤医院放疗科收治的108例原放疗区域再次局部复发的鼻咽癌患者纳入研究.按照AJCC/UICC2002版分期划分为Ⅰ~Ⅳ期的患者人数分别占31.5%、8.3%、32.4%、27.8%.中位复发间期为51个月(8~276个月).所有患者接受了IMRT的照射,运用6MV光子照射7~9个野.不良反应根据美国国立癌症研究所CTC?3.0评估标准(common?toxicity?criteria,?version?3.0)进行评估.结果:至2012年9月,全组患者5年总生存率、无进展生存率、局部无复发生存率及无转移生存率分别为59%、56%、52.9%及55.8%.随访期间死亡44例,19例死于鼻咽大出血,其余死亡原因为器官衰竭及肿瘤转移.有24例患者出现不同部位3~4级的不良反应.在预后分析中,年龄、T分期及总分期为总生存及无复发生存的重要预后因素,其中T分期也是无进展生存及无转移生存的重要预后因素.在多因素分析中,年龄、总分期对总生存预后影响的差异有统计学意义(P<0.05).结论:IMRT为复发性鼻咽癌比较有效的治疗方式,能更好地增加局控并有效提高生存率,但高剂量的再次放疗易导致鼻咽黏膜坏死和大出血,多数患者因此突然死亡;且再次放疗后部分患者后遗症较严重,影响生活质量.年龄较小、T分期以及总分期较早是IMRT治疗的良好预后因素.
배경여목적:목전복발비인암진치곤난,본연구통과전첨성연구응용조강괄형방료(intensity-modulated? radiation? therapy,IMRT)치료복발성비인암,평개료효급불량반응,병진행상관림상예후인소분석.방법:장2006년6월—2010년9월경복단대학부속종류의원방료과수치적108례원방료구역재차국부복발적비인암환자납입연구.안조AJCC/UICC2002판분기화분위Ⅰ~Ⅳ기적환자인수분별점31.5%、8.3%、32.4%、27.8%.중위복발간기위51개월(8~276개월).소유환자접수료IMRT적조사,운용6MV광자조사7~9개야.불량반응근거미국국립암증연구소CTC?3.0평고표준(common?toxicity?criteria,?version?3.0)진행평고.결과:지2012년9월,전조환자5년총생존솔、무진전생존솔、국부무복발생존솔급무전이생존솔분별위59%、56%、52.9%급55.8%.수방기간사망44례,19례사우비인대출혈,기여사망원인위기관쇠갈급종류전이.유24례환자출현불동부위3~4급적불량반응.재예후분석중,년령、T분기급총분기위총생존급무복발생존적중요예후인소,기중T분기야시무진전생존급무전이생존적중요예후인소.재다인소분석중,년령、총분기대총생존예후영향적차이유통계학의의(P<0.05).결론:IMRT위복발성비인암비교유효적치료방식,능경호지증가국공병유효제고생존솔,단고제량적재차방료역도치비인점막배사화대출혈,다수환자인차돌연사망;차재차방료후부분환자후유증교엄중,영향생활질량.년령교소、T분기이급총분기교조시IMRT치료적량호예후인소.
?Background and purpose:Treatment for locally recurrent nasopharyngeal carcinoma(NPC) was difficult and complicated. This study aimed to study for the treatment outcome, radiation toxicity and the prognostic factors in patients with locally recurrent NPC treated with intensity-modulated radiation therapy (IMRT) in our cancer center.?Methods:An analysis of 108 NPC patients with local recurrence who were re-irradiated with IMRT between 2006 and 2010 was conducted. According to the 2002 American Joint Committee on Cancer Stage Classification, the distribution of disease restaging was 31.4 % for stageⅠ, 8.3% for stageⅡ, 32.4% for stageⅢ and 27.7% for stageⅣ. Median time from initial radiotherapy to the nasopharyngeal recurrence was 51 months (range, 8-276). All patients were treated with 6MV photon with 7-9 fields using IMRT. The toxicities were evaluated by Common Toxicity Criteria (CTC), version 3.0. Results:The 5 year overall survival, progression free survival, local recurrence-free survival and distant metastasis-free survival were 59%, 56%, 52.9% and 55.8%, respectively. 44 patients died,19 patients died of nasopharynx hemorrhea, the others died of metastasis or exhaustion. Grade 3–4 toxicities were reported in 24 patients. In a univariate analysis, patient age, recurrent T, recurrent stage were significant prognostic factors for overall survival and local recurrence-free survival. Recurrent T also was the prognostic factors for progression free survival and distant metastasis-free survival. In a multivariate analysis, patient age and recurrent stage remained significant for overall survival. Conclusion:Re-irradiation using IMRT is available to improve local tumour control and to prolong patients’ survival. High dose prescription may result in radio-necrosis of nasopharyngeal mucosa and bleeding. The hemorrhea was the main death cause. The incidence of serious toxicities was also serious; and affected the quality of life. Younger patient ages, lower T stage and recurrent stage are independent prognostic factors for overall survival and local recurrence free survival of recurrent NPC.