鼻咽癌体外加腔内放疗临床观察

 本资料观察分析了本院1997年正月至12月收治的31例鼻咽癌采用体外加腔内高剂量率近距离放疗。与97年以前30例鼻咽癌肿瘤消失慢或足量未控而单纯体外加量的病例进行临床比较,体外加腔内高剂量率近距离放疗,肿瘤消退较单纯体外常规放疗快,鼻咽腔粘膜反应二组差异不大,而口腔粘膜反应前组较后组轻。     

高剂量率近距离治疗鼻咽癌的近期疗效

高剂量率近距离治疗鼻咽癌的近期疗效胡国清，胡长耀，于世吴，管竞贤，陈元，黄河，栾庆珍，张柏华１９９０年１０月～１９９２年４月，我科采用体外照射加高剂量率腔内治疗鼻癌５８例，其中首程治疗３７例，根治性外照射后局部复发２１例。全部病人均采用体外照射加腔内...     

外照射加腔内近距离放射治疗鼻咽癌的临床观察

我院放疗科自1992年4月～1994年4月外照射加腔内距离放射治疗鼻咽癌70例,均经病理证实。首程治疗60例,鼻咽复发癌再程治疗10例。本组(结合组)与同期单纯外照射组的1、2、3年生存率没有明显统计学差异。两组中的鼻咽复发癌再程放疗的1、2、3年生存情况亦没有明显统计学差异。放疗后复发情况:结合组的鼻咽腔内复发率明显低于单纯外照射组,但其颅底与咽旁间隙的复发率,两组没有明显差异。采用腔内近距离放疗病人的鼻咽粘膜反应较单纯外照射重,鼻咽复发癌腔内放疗后易出现鼻咽出血。给我们的提示是:对鼻咽腔周围病变,外照射致局部控制没有把握时,不宜盲目行腔内近距离放疗。一般情况下,腔内近距离放疗只是腔内加量放疗,做为外照射的补充治疗,剂量不宜过高。     

超分割放疗加近距离治疗联合化疗治疗N2、N3期鼻咽癌的疗效观察

目的评价后程加速超分割放疗加高剂量率后装近距离治疗联合化疗治疗N2、N3期鼻咽癌的近期疗效及毒副反应.方法将80例N2、N3期鼻咽癌随机分为后程加速超分割放疗加高剂量率后装近距离治疗联合化疗组(综合组)和单纯放疗组(常规组).综合组于放疗前先行诱导化疗1次;化疗后先行常规分割照射至鼻咽部剂量为40GY,缩野后改用加速超分割照射至鼻咽部剂量为67GY,体外照射结束后加用高剂量率后装腔内治疗1～2次;于后装治疗结束后再行辅助化疗2次.常规组放疗采用常规分割,鼻咽部总剂量为70GY.结果综合组和常规组鼻咽肿瘤完全消退率分别为92.5%和75%,颈部转移淋巴结控制率为85%和55%(P＜0.05),CT扫描检查鼻咽肿瘤完全消退率为72.5%和47.5%(P＜0.05).综合组消化道血液毒性大于常规组,但可耐受.结论后程加速超分割放疗加高剂量率后装近距离治疗联合化疗治疗N2、N3期鼻咽癌可提高鼻咽癌的局部控制率,毒副反应可以耐受.     

外照射加腔内近距离放射治疗鼻咽癌的临床研究

外照射加腔内近距离放射治疗鼻咽癌的临床研究王安宇，王绍丰，陈铭忠，朱小东本院自１９９１年１月至１９９３年９月对２４８例鼻咽癌进行外照射加腔内近距离放疗和单纯外照射作临床对照研究，报告如下。１资料与方法：均经病理证实，均为首程治疗，临床分期采用９２分期...     

Ⅰ、Ⅱ期鼻咽癌外照射加腔内放疗远期疗效的前瞻性研究

背景与目的:近距离放疗的空间剂量分布和外照射明显不同,两者联合使用可以优势互补,提高剂量分布的适形度.本研究旨在探讨Ⅰ、Ⅱ期鼻咽癌患者采用单纯外照射放疗与外照射加腔内联合放疗的长期疗效差异.方法:将321例Ⅰ、Ⅱ期鼻咽癌患者,随机分为单纯外照射组223例,外照射加腔内联合放疗组98例;单纯外照射组采用低熔点铅挡块不规则野照射,常规方法照射,常规分割,总剂量为66～74 Gy;联合放疗组采用同样的外照射方法,总剂量给与58～62 Gy,接着给予15～20 Gy腔内近距离放疗.结果:经过5年的随访,单纯外照射组鼻咽复发16例,死亡35例,Ⅰ、Ⅱ期鼻咽癌患者的5年生存率分别为90.63%和80.82%(P=O.018);联合照射组鼻咽复发1例,死亡6例,Ⅰ、Ⅱ期鼻咽癌的5年生存率分别为95.24%和93.36%(P=0.025).口干和张口困难的不良反应以联合照射组较轻.结论:Ⅰ、Ⅱ期鼻咽癌患者采用外照射加腔内放疗相对单纯外照射有较好的疗效并可减轻不良反应.     

鼻咽癌外照射加腔内放疗的疗效观察

目的 探讨腔内放疗对鼻咽癌外照射后鼻咽腔内未消退病灶的治疗效果.方法 对78例鼻咽癌外照射后(66～74 Gy)鼻咽腔内未消退病灶行高剂量率近距离放疗,外照射结束后休息5～7 d进行鼻咽近距离后装治疗,单次剂量6～8 Gy,总剂量12～16Gy/2次.结果 CR 76例,PR 2例,中位随访期17个月,无严重毒副反应发生,口干和张u困难较轻.结论 采用外照射加腔内放疗是控制鼻咽癌外照射后未消退病灶的有效治疗方法,并可减轻毒副反应.     

鼻咽部后装放疗模具施源器的设计制作和临床应用

鼻咽部后装放疗模具施源器的设计制作和临床应用陈南江廖天禄李杭姜桂林张其昆我们于１９９２年１月引进深圳威达医疗器械公司生产的ＷＤ－ＨＤＲ１８型高剂量率近距离遥控后装放射治疗机，用于腔内后装放疗配合外放射治疗鼻咽癌３８例，共８６人次，局部肿瘤退缩满意，观...     

治疗鼻咽癌成为上医大肿瘤医院特色

上海医科大学肿瘤医院不断改进放疗技术,采用多种方法治疗鼻咽癌,疗效达国内外最佳水平。上海肿瘤医院每年收治600例一700例患者。对不同的患者选用不同的治疗方案,在治疗方面已形成一大特色。建国前,我国鼻咽癌的5年生存率为零。70年代,该院鼻咽癌单纯钴60体外放疗总的5年生存率提高到54%;应用钻60体外放疗加腔内镭疗,5年生存率为68%。80年代应用钴60后装腔内放疗配合体外放     

高剂量率^192Ir后装近距离放疗中晚期直肠癌

目的：分析高剂量率＾１９２Ｉｒ后装近距离放疗在中晚期直肠癌中的价值。方法：３８例中晚期直肠癌,综合组高剂量＾１９２Ｉｒ后装近距离放疗结合外照射放疗２０例,对照组单纯外照射１８例。高剂量率＾１９２Ｉｒ后装近距离放疗根据肿瘤形态采用组织间插植术和腔内放疗,２周４次完成,总剂量２４Ｇｙ－２８Ｇｙ。１周后外加 照射。对照组外照射盆腔野总剂量４５Ｇｙ－５０Ｇｙ,２次／ｄ。结果：临床证状改善,局部肿瘤消退情况     

鼻咽癌局部复发适形放疗近期疗效分析

目的：采用适形放疗提高鼻咽癌局部复发的治疗效果,探讨最佳剂量分割方法。方法：1997年9月至2000年2月对41例鼻咽癌局部复发病人行适形放疗。27例常规外照射39Gy,在3周内分30次完成后进行低分割适形放疗,80％等剂量线4～7Gy/次,总量20～24Gy,分4次在2周内完成;14例全程超分割适形放疗,90％等剂量线59.8Gy,4.6周内分46次完成。结果：适形放疗的等剂量线分布在三维方向上与靶区适形。急性放射性粘膜炎、后组颅神经损伤、张口困难两组相似,低分割组22％鼻咽粘膜坏死,3.7％视神经损伤。超分割组无鼻咽粘膜坏死、视神经损伤。两组治疗有效率均达93％。结论：鼻咽癌局部复发病人采用超分割适形放疗取得满意的近期效果,低分割适形放疗不宜采用。     

体外照射联合^252Cf中子后装治疗T1、T2期鼻咽癌的临床研究

目的比较单纯常规体外照射与体外照射联合^252Cf中子后装治疗T1、T2期鼻咽癌原发灶的局部控制疗效和并发症。方法对30例初治的T1期和部分T2期鼻咽癌病例进行体外照射联合^252Cf中子后装治疗。结果全部病例随访2年,鼻咽局部复发2例,2年局部控制率93．3％,远处转移4例,张口困难2例,无一例患者发生软腭穿孔。结论体外照射联合^252Cf中子后装治疗鼻咽癌,增加了鼻咽腔内照射剂量,提高了局部控制率,减少了鼻咽癌外照射剂量,有利于降低张口困难的发生率。     

鼻咽癌放疗后局部残存补量

 目的　分析鼻咽癌放射治疗后局部残存补量照射的价值。方法　 1975年 11月～ 2 0 0 0年 12月根治性放疗 4 4 2例鼻咽癌中的 87例患者放疗后局部病变残存。根治性放射治疗后局部残存 6 0例患者接受常规外照射补量 ,19例患者给予常规外照射联合腔内照射 ,8例患者行适形放疗补量。结果　根治性放疗后肿瘤完全缓解者 5年生存率 5 4 .5 % ,肿瘤残存外照射加量组 5年生存率 5 7.6 %。结论　放疗后局部残存补量照射可进一步改善生存。最佳的适应症、挽救剂量、挽救方法仍需探讨     

三维适形放射治疗鼻咽癌后程大分割的剂量学研究

目的寻求1种较理想的鼻咽癌三维放疗的分割方式,从而提高局部控制率。方法对15例行三维适形放射治疗的鼻咽癌患者进行模拟的剂量学研究,将后程大分割（分次量2.5Gy和3.0Gy）与常规分割（2.0Gy）进行剂量学对比。结果大分割放疗可以较大幅度增加肿瘤区（GTV）的剂量。2.5组脊髓最大剂量、腮腺、颞颌关节、脑干平均剂量提高均不超过1.0Gy,脑干最大剂量增加2.3Gy。3.0组腮腺及颞颌关节的平均剂量增加幅度较大达3.4Gy和1.4Gy,脑干最大剂量增加4.5Gy。结论分次量2.5Gy的后程大分割放疗能够较大幅度地增加GTV剂量,且对正常器官的剂量增加幅度较小,并发症增加较少。     

Nasopharyngeal Carcinoma: Treatment of Neck Node Recurrence by Radiotherapy

The records of 91 nasopharyngeal carcinoma patients who were treated with external radiotherapy for recurrent neck node disease were reviewed. All patients had received prior radiotherapy for cervical nodal disease or prophylactic neck irradiation. The node size (product of the greatest perpendicular diameters) at the time of treatment for nodal relapse ranged from 1cm² to 35cm² (median 2.25cm²). The radiation dose ranged from 823 RETs to 1949 RETs (median 1520 RETs). The recurrent node size and radiation dose were found significant prognostic factors for local control. The local tumour control for nodes 4cm³ or smaller was 51% at five years, for nodes greater than 4cm³ was 16% at 18 months (p=0.0'l). The overall 5 year survival was 19.7%. Radiation dose greater than 1600 RETs was significantly associated with better survival for patients with recurrent nodes measured 4cm or smaller, but higher radiation dose did not improve the survival of patients with recurrent nodes greater than 4cm². Because of the dilemma of suboptimal control resulting from inadequate radiation dose when compared with surgical treatment, and possible radiation complication from higher dose, surgery should be the treatment of choice for neck node recurrence after primary radiotherapy for nasopharyngeal carcinoma.     

立体定向放射治疗加量照射对鼻咽癌局部控制率影响的临床探讨

 目的　探讨立体定向放射治疗 ( SRT)加量照射对鼻咽癌局部控制率的影响。方法　 1 6例鼻咽癌初治患者 ,常规外照射 64～ 72 Gy后 ,给予 SRT鼻咽部加量照射 1 2～ 2 5 Gy/3～ 5次。结果　随访 6～ 2 4月 ,1例失访 ,1例 1 4月后死于鼻咽大出血 ,局部控制率为 1 4/1 5例。患者口干、口腔粘膜反应等放射反应较单纯外照射无明显增加。结论　立体定向放射治疗用于鼻咽癌常规放疗后局部加量照射 ,能显著提高局部控制率 ,放疗并发症并无增加 ,是提高鼻咽癌疗效的较好方法.     

Intracavitary radiation treatment of nasopharyngeal carcinoma by the high dose rate afterloading technique

Sixty-four patients with nasopharyngeal carcinoma were treated by various combinations of external irradiation with intracavitary radiotherapy using the high dose rate afterloading technique. The afterloading intracavitary radiation (AIR) was given as a routine boost or for residual or recurrent disease. The external irradiation dose varied from 45 to 70 Gy, whereas the AIR dose ranged from 10-50 Gy, depending on the nature of the primary nasopharyngeal lesion. The results were quite encouraging, although the longest follow-up so far has only been just over 4 years. Of 13 such cases that received external radiotherapy plus AIR as primary treatment, 12 have survived. However, of the 9 cases who received AIR for local recurrence after external radiotherapy, only 5 survived. Of the total of 64 cases treated by AIR from June 1981 to May 1986, 54 are alive. No serious radiation sequelae have been observed. It can be concluded that AIR for nasopharyngeal carcinoma is indicated for boosting the dose to the nasopharyngeal cavity with appropriate reduction in external irradiation dose, and for residual or recurrent disease after primary external radiotherapy.     

Prospective phase II trial of concomitant boost radiotherapy for stage II nasopharyngeal carcinoma

Stage II nasopharyngeal carcinoma (NPC) treated with conventionally fractionated radiotherapy results in suboptimal outcome. This report aims to document the outcome of Stage II NPC patients treated with external beam radiotherapy delivered using an accelerated concomitant boost (C-Boost) schedule. Forty-seven 1997 AJCC Stage II NPC patients were enrolled and analyzed in this prospective phase II clinical trial. The primary tumor and clinically involved nodes received a total dose of 72Gy in 42 fractions. C-Boost for gross disease consisted of 18Gy in 12 fractions commencing on day 19, and delivered at least 6h after the first dose. Patients were assessed for response, survival and toxicity. With a median follow-up of 30 months, 4 patients developed local recurrence only, 2 had persistent neck nodal disease or recurrence, and 1 with both locoregional recurrences. Distant metastases were seen in 5 patients, with or without locoregional recurrence. A total of 5 patients succumbed from nasopharyngeal cancer: four from effects of distant metastases and 1 from progressive local disease. The 3-year local, regional, and overall survival rates were 87.1%, 92%, and 85.9%, respectively. All patients experienced some degree of acute and/or late toxicity. Moderate to severe late toxicities (grade 3 and 4) were observed in 17% of cases. This C-Boost radiotherapy regimen administers a higher biologically effective dose compared with conventional radiation schedules. The local control after C-Boost radiation seems high for patients with stage II nasopharyngeal carcinoma, thus justifies further investigation to confirm its efficacy.     

早中期鼻咽癌外照射联合腔内放疗长期疗效的前瞻性研究

[目的]探讨Ⅰ、Ⅱ期鼻咽癌患者采用单纯外照射放疗与外照射加腔内联合放疗的长期疗效。[方法]前瞻性研究453例Ⅰ、Ⅱ期鼻咽癌患者,随机分为单纯外照射组297例,联合照射组156例;单纯外照射组采用低熔点铅挡块不规则野照射,常规照射,常规分割,总剂量为66～74Gy;联合照射组采用同样的外照射方法,总剂量给予58～62Gy,并给予15～20Gy腔内近距离放疗。[结果]单纯外照射组和联合照射组的5年鼻咽局控率分别为Ⅰ期92.86%、96.43%（P=0.35）,Ⅱ期89.02%、94.53%（P=0.01）;5年总生存率分别为Ⅰ期88.10%、92.86%（P=0.27）,Ⅱ期81.18%、90.63%（P=0.03）。口干和张口困难的毒副反应联合照射组比单纯外照射组轻。[结论]Ⅰ、Ⅱ期鼻咽癌患者采用常规外照射联合腔内放疗相对单纯常规放疗有较好的疗效,并可减轻毒副反应。