局部复发鼻咽癌超分割IMRT的临床分析

目的 分析LR鼻咽癌行再程超分割IMRT的临床疗效和不良反应。方法 2011—2015年间28例接受超分割IMRT患者入组,中位复发时间为17.5个月,其中男23例、女5例,年龄25~74岁。肿瘤局部剂量60~70 Gy,1.2 Gy/次,2 次/d,间隔6 h以上,每周连续治疗5 d。25例患者同期接受了奈达铂单药或联合方案化疗,4例接受了今又生p53基因治疗,6例接受EGFR单抗靶向治疗。结果 超分割IMRT后3个月,CR、PR率分别为89%(25/28)、11%(3/28)。中位随访27.5个月,1,2,3年OS、LRFS、PFS分别为100%、91%、80%,100%、80%、55%,88%、65%、55%。3例患者治疗后出现3级鼻咽黏膜溃疡坏死,经对症处理后好转。多因素分析PFS预后不良因素包括肿瘤分期rT₃—T₄期(P=0.00)、无化疗(P=0.04)。结论 超分割IMRT对复发鼻咽癌有良好的LC效果,不良反应可控,值得临床推荐试用。

Efficacy of intensity-modulated radiotherapy on patients with locally recurrent nasopharyngeal carcinoma

Objective This study retrospectively analyzed the efficacy and toxicity profile of hyperfractionated intensity-modulated radiotherapy (HF-IMRT) for locally recurrent nasopharyngeal carcinoma (NPC).Methods Twenty-eight locally recurrent patients of NPC were enrolled,23 male and 5 female with a median of 51 years (range 25-74 years).All patients had a median recurrent time of 17.5 months and received HF-IMRT with a total dosage of 60-70 Gy,each consisting of 1.2 Gy per fraction,each of the 2 fractions were spaced 6 hours apart and lasting for 5 days.Twenty-five patients received concurrent chemotherapy of nedaplatin or two agent regimen,4 patients received Ad-p53 gene therapy and 6 patients received target therapy of EGFR monoclony antibody.Results The complete response and partial response rates were 89％ (25/28) and 11％ (3/28) after being treated by HF-IMRT for 3 months.The median follow-up time was 27.5 months.The 1,2,3-year overall survival rates,locoregional recurrence-free survival rates and progression-free survival rates were 100％,91％,80％;100％,80％,55％;88％,65％,55％,respectively.Three patient were observed to develop severe nasopharyngeal necrosis but recover after treatment,no patients experienced hemorrhage of nasopharynx.Multivariate analysis indicated that the poor prognostic factors included tumor stages (T3-T4) (P=O.O0) and no chemotherapy (P=O.04).Conclusion HF-IMRT is feasible for locally recurrent nasopharyngeal carcinoma with satisfactory local control and controllable adverse reaction,it is worth further clinical studies.