T3～T4N0～N3期鼻咽癌单纯放疗疗效分析

目的 探讨不同T分期与N分期对局部晚期鼻咽癌单纯放疗疗效的影响。方法 回顾分析556例T3～T4N0～N3期（1992年福州分期）鼻咽癌初治患者临床资料。全组病例均采用面颈联合野照射技术给予单纯常规放疗。原发灶照射总剂量66～80Gy（6.5～8．0周完成），颈淋巴结转移灶照射总剂量60～70Gy（6～7周完成）。结果 全组病例5年总生存率为66．4％。T3期5年总生存率为69．1％，T4期的为59.0％（P〈0．05）；两者局部控制率、无瘤生存率、无复发生存率以及无转移生存率均无差别。N0、N1、N2、N3期的5年总生存率分别为74．0％、66．0％、57．6％、29．4％（P〈0．01），N分期越高复发率和远处转移率越高。结论 单纯常规放疗的局部晚期鼻咽癌患者中。N分期是影响疗效及预后的主要因素，T分期为次要因素。对不同N分期的局部晚期鼻咽癌患者进行分层放化疗，对于解决治疗失败的原因——复发与远处转移也许会起到积极和有效的作用。

Radiotherapy alone for T3 ～ T4N0 ～ N3 nasopharyngeal carcinoma

Objective To discuss the impact of different T and N stages for local-regional advanced nasopharyngeal carcinoma(NPC) on the clinical gains of radiotherapy(RT) alone. Methods From January to December in 1999, the data of 556 patients with 92' Fuzhou Staging System T3-4N0-3 in China were initially treated by conventional RT alone with the facio-cervical field were retrospectively reviewed. The total dose was 66-80Gy/6.5-8.0 weeks in the nasopharyngeal lesion, and 60-70Gy/6-7 weeks for the neck lymph nodes. Results The overall 5-year survival rate(OS) was 66.4%, with 69.1%,59.0% for T3,T4 lesions( P<0.05). However, the difference between local control, disease-free survival, relapse-free survival or metastasis-free survival rate was not significant in T3,T4 lesions. The 5-year OS was 74.0%,66.0%,57.6% and 29.4% in N0,N1,N2 and N3 lesions, respectively(P<0.01).The higher the N stage, the higher relapse and distant metastasis rate. Conclusions N stage is the dominant factor influencing the effect and prognosis of patients with local-regional advanced NPC treated by conventional RT alone. T stage was only the minor correlative factor. Using stratified combined radio-chemotherapy modality for different N stages of local-regional advanced NPC may act positively and effectively on resolving the cause of treatment failure--relapse and distant metastasis.