111例初治鼻咽癌调强放射治疗临床疗效分析

目的分析调强放射治疗（IMRT）鼻咽癌的初步临床结果。方法选择111例初治鼻咽癌患者进行IMRT．其中男性76例，女性35例：年龄22～71岁，中位年龄47岁。根据国际抗癌联盟2002年分期标准，Ⅰ期19例．Ⅱ期58例．Ⅲ期32例，Ⅳa期2例。对鼻咽肿瘤计划靶区（PTV）放射治疗至60～65Gy时根据肿瘤退缩情况，缩野加量至70～75Gy。中下颈65～70Gv，锁骨上区52Gy，危及器官剂量在安全限制范围内，脑干、脊髓平均剂量36．5Gv，左、有视神经47．2Gv、43.4Gy，左、右腮腺剂量40．1Gy,39．6Gy,50％腮腺体积平均受照剂量在30Gy以下。结果中位随访期38个月，22例出现局部或淋巴结复发，局部复发率1年、2年分别为5．4％、14．4％。1年、2年、3年总生存率分别为98.2％、94．6％和85．6％。急性反应主要以口腔黏膜放射性损伤、骨髓抑制和口干为主。口腔黏膜Ⅰ度损伤为22．5％，Ⅱ度、Ⅲ度损伤分别为44．1％、33-3％。骨髓抑制Ⅰ级发生率为31．5％．Ⅱ级3412％．Ⅲ级14．4％。未发现放射性脑损伤后遗症。结论IMRT对于鼻咽癌各区均有较好的剂量分布，局部控制率和2年、3年总生存率有明显提高．且可较好地保护正常组织免受照射，IMRT逐渐成为鼻咽癌标7佯的治疗方式

Intensity modulated radiation therapy for 111 cases of primitive nasopharyngeal carcinoma

Objective To evaluate the effects of intensity modulated radiation therapy （IMRT） for the treatment of primitive nasopharyngeal carcinoma. Methods A total of 111 patients with primitive nasopharyngeal carcinoma received IMRT were enrolled, included 76 males and 35 females, who were aged 22 - 71 years with a median age of 47. Nineteen patients were in stage Ⅰ , 58 patients stage Ⅱ, 32 patients stage m and 2 patients stage Ⅳa. The prescribed dose 60 - 65 Gy was delivered to plan tumor volume（PTV）, lessened ilxitation field and increased dose of 70 - 75 Gy were given when tumor volume was reduced. The dose of IMRT at middle and low neck was 65 - 70 Gy, 52 Gy for supraelavicular area, 36.5 Gy for brainstem and spinal cord, 47.2 Gy and 43.4 Gy for left and right optic nerve, 40.1 Gy and 39.6 Gy for left and right parotid, and less than 30 Gy for parotid, respectively. Results The median follow-up time was 38-month, local and lymph nasopharyngeal carcinoma reoccmTed in 22 patients. The 1-year and 2-year local recurrent rates were 5.4 % and 14.4 %. The 1-year, 2-year and 3-year survival rates were 98.2 %, 94.6 % and 85.6 %, respectively. Mucositis, bone marrow suppressing and xerostomia were the most common acute reactions. Grade Ⅰ , Grade Ⅱ and Grade Ⅲ mucositis were 22.5 %, 44. 1% and 33.3 % respectively; Grade Ⅰ , Grade Ⅱ and Grade m bone marrow suppressing were 31.5 %, 34.2 % and 14.4 %, respectively; the radiation cranial injury was not observed in all patients. Conclusion It is demonstrated that IMRT could achieve satisfactory dose distribution for nasopharyngeal carcinoma, it could also protect normal tissues and improve local control rate. IMRT could become the standard method for the treatment of nasopharyngeal carcinoma.