摘要
目的比较计划性外照射加腔内近距离治疗和单纯外照射对早期鼻咽癌的５年局部控制率、５年生存率以及后遗症。材料与方法自１９９０年３月到１９９６年１１月，对１２４例Ｔ１、Ｔ２初治的鼻咽癌患者进行了前瞻性随机分组研究。男性８６例，女性３８例。中位年龄４７岁。全部病例均经病理证实，除１例为腺鳞癌外，余均为低分化鳞癌，Ｋａｒｎｏｆｓｋｙ评分均≥８０分，中位随诊期：６２个月（５～８４个月）。全组外照射采用６～８ＭＶ－Ｘ线，腔内近距离治疗采用高剂量率１９２Ｉｒ微源。随机分组方法：全部病例先采用常规外照射技术（面颈联合野加耳前野），ＣＴ或ＭＲＩ提示咽旁间隙未受侵者外照射剂量予ＤＴ５０～６０Ｇｙ，咽旁间隙受侵者予ＤＴ５０～７０Ｇｙ。然后行鼻咽ＣＴ或ＭＲＩ检查，对于咽旁间隙肿瘤消退满意的病例，采用信封法分为单纯外照射组（ＲＴ）６０例和计划性外照射加腔内近距离治疗组（ＲＢ）６４例。ＲＴ组则继续外照射至根治剂量，７０～８６Ｇｙ（中位剂量７５Ｇｙ）。ＲＢ组则在休息１周后采用腔内近距离治疗加量。每周治疗１次，除７例因在外照射至鼻咽ＤＴ４０～５５Ｇｙ时肿瘤已完全消失的患者仅行１次腔内治疗外，余５７例均接受了２～３次腔内近距离治疗。剂量参考点?
Purpose To compare the local control rate and side effects of external radiation combined with brachytherapy and external radiation alone for early nasopharyngeal carcinoma (NPC). Materials and Methods A total of 124 patients with T1, T2 NPC was evaluated in this study between March 1990 and November 1996. The median followup periods were 62 months with 5 cases lost. There were male 86, female 38. The ages ranged from 16～70 yrs. Poorly differentiated squamous cell carcinoma except 1 adenosquamous cell carcinoma were proved by histopathology at the primary sites. The external radiation was given by 6～8 MV Xrays and 192 Ir was used for intracavitary brachytherapy. The patients treated by RT alone group received a total dose of 70～86 Gy in 7～9 weeks and that of RB group was 50～70Gy in 5～7 weeks. The dose of brachytherapy ranged 8～24 Gy in 1～3 fractions in 1～3 weeks . KaplanMeier and logrank test were used for evaluating the results of the local control and survival rates in this series. Results Two patients in the RT group presented resistant disease in the primary site were salvaged by brachytheray. Eight patients had local recurrence (2 in RB, 6 in RT group). The 5year local control rates were 93.9% in RB group, and 85.2% in the RT group (P>0.05). The 5year survival rates were 88.0% and 85.2% in the RB and RT groups (P>0.05). Three patients developed bleeding in the nasopharynx and all of them died from it. No necrosis of nasopharyngeal mucosa or perforation of soft palate was observed in this series.Conclusion Both RT and RB groups present a satisfactory 5year local control and survival rates in this study. Although the 5year local control rate seems better in the RB group than the RT, no significant difference was observed. The lower dose of external radiation in the RB group may cause milder complication than the higher dose of external radiation without reducing the local control rate. Appropriate brachytheray technique is able to render the treatment safe and effective.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
1997年第4期206-211,共6页
Chinese Journal of Radiation Oncology
关键词
鼻咽癌
放射治疗
外照射
近距离治疗
nasopharyngeal carcinoma brachytherapy randomized study radiation
