鼻咽癌合并皮肌炎12例临床分析

目的：探讨鼻咽癌合并皮肌炎的患者大量服用强的松对放疗疗效的影响。方法：治疗组：12例合并皮肌炎的鼻咽癌患者接受常规放射治疗,同时服用较大剂量的强的松。对照组：同期12例单纯鼻咽癌患者接受常规放射治疗,分别与治疗组病例配对比为对照。2组病例在性别、年龄、临床分期和放疗方法上无显著性差异。结果：治疗组1、3、5年生存率分别为91．7％、66．7％和33．3％;对照组分别为100．0％、75．0％和50．0％（P＞0．05）。治疗组死亡8例,其中死于鼻咽癌癌复发3例,远处癌转移4例,重度皮肌炎1例;对照组死亡6例,其中死于鼻咽癌癌复发2例,远处癌转移4例（P＞0．05）。结论：合并皮肌炎的鼻咽癌的放疗疗效与单 鼻咽癌的放疗疗效相近;鼻咽癌合并皮肌炎的患者大量服用强的松未明显增加鼻咽癌复发及远处转移的发生。     

鼻咽癌颈部淋巴结转移切取活检对其预后的影响

目的分析颈部肿物切取活检对鼻咽癌放疗的影响。材料与方法１９８３年２月～１９８６年４月间收治有颈部淋巴结转移的鼻咽癌１０８例，其中经鼻咽部活检者６５例，经颈部切取活检者４３例，全部行根治性放疗。结果鼻咽部活检组３，５年生存率分别为６０．０％及５５．４％；颈部切取活检组３，５年生存率分别为３９．５％及３４．９％。鼻咽活检组５年死亡病例的远处转移率为５９．３％；颈部切取活检组为８５．７％，均具有显著性差异（Ｐ＜０．０５）。结论鼻咽癌颈部淋巴结转移切取活检可增加其远处转移率，降低生存率。     

放射治疗后加化疗治疗中晚期鼻咽癌的临床观察

１９８９年３月至１９９１年１月，作者将经病理诊断且为初治的１６７例Ⅲ、Ⅳ期鼻咽癌病人，随机分为单纯放疗组和综合治疗组（放疗后加ＣＯＢ方案化疗），进行疗效对比。结果：单纯放疗组８８例的５年生存率为３０．７％，综合治疗组７９例为４０．５％；两个治疗组中的Ⅲ期病人，分别为３８．９％和５２．０％（Ｐ＞０．０５）；两组原发灶及颈淋巴结复发率，复发中位时间基本相同；两组Ⅲ期病人的远处转移发生率分别为２４．０％及３３．３％（Ｐ＞０．０５）；出现远处转移的中位时间，综合组比单纯放疗组延迟（Ｐ＜０．０５）；两组患者的主要死亡原因为复发和转移，两组死亡病例的中位生存期，综合组长于单纯放疗组（Ｐ＜０．０５）；远期后遗症的发生率，综合组高于单纯放疗组（Ｐ＜０．０１）。     

初治鼻咽癌合并皮肌炎86例临床配对研究

[目的]分析初治鼻咽癌合并皮肌炎患者的临床特点,探讨其放疗疗效、毒副作用及预后因素。[方法]86例鼻咽癌合并皮肌炎患者和单纯鼻咽癌患者(对照组)进行配对研究,Kaplan-Meier法计算生存率,Log-Rank检验比较两组生存差异;Mann-WhinetyU检验比较两组急性及晚期放疗反应发生情况;Cox回归模型对合并皮肌炎组进行预后多因素分析。[结果]合并皮肌炎组1、3、5年总生存率分别为86.9%、70.2%、58.1%,对照组分别为96.4%、81.1%、62.7%,差异无统计学意义(χ2=1.254,P=0.263)。合并皮肌炎患者使用激素治疗无明显生存获益。合并皮肌炎组患者急性放疗反应较对照组严重(P<0.05)。单因素分析显示性别、年龄、TNM分期、T分期、N分期是影响鼻咽癌合并皮肌炎的预后因素,Cox回归模型分析显示性别、TNM分期、化疗是独立预后因素。[结论]鼻咽癌合并皮肌炎患者疗效与单纯鼻咽癌患者相近,但其放疗急性反应较重;性别、TNM分期、化疗是其预后的独立影响因素。     

鼻咽癌远处转移281例的临床分析

目的：探讨鼻咽癌远处转移的规律和治疗方法：方法：对281例鼻咽癌远处转移的临床资料进行回顾性分析。结果：鼻咽癌远处转移率20．3％（281／1383），其中肺转移42．7％（120／281），骨转移32．4％（91．281），肝转移21．4％（60／281），放疗后1－2年发生转移47．7％（134／281），结论：大部分鼻咽癌远处转移放疗后2年内，常见转移是肺，骨，肝，放疗前新辅助化疗和放疗后辅助化疗可减少鼻咽癌远处转移及提高生活质量。     

鼻咽癌茎突后间隙侵犯的临床意义探讨

目的探讨鼻咽癌茎突后间隙侵犯的临床意义。方法１９８例Ｉ～Ⅳａ期鼻咽癌住院初治患者接受根治放疗。按茎突后间隙有无侵犯分为茎后侵犯组和茎后无侵犯组。应用Ｋａｐｌａｎ－Ｍｅｉｅｒ，Ｌｏｇ－Ｒａｎｋ及卡方检验等方法对两组病人５ａ生存率、局控率和无远处转移生存率进行分析和评价。结果两组５ａ生存率分别为４６．７６％和６８．８８％（Ｐ＝０．００２７），两组无远处转移生存率分别为７１．６８％和８４．２２％（Ｐ＝０．０４６８）。结果表明茎突后间隙侵犯者生存率和局控率降低，远处转移增多。结论茎突后间隙的侵犯是影响预后的重要因素之一，在分期上将之划归Ｔ３是合理的；在鼻咽癌放射治疗设计中，鼻咽、咽旁特别是茎突后间隙、颅底、上颈淋巴结引流区应设置在同一靶区内。     

鼻咽癌原发灶腔内微波热疗及CT观察

目的探讨腔内微波热疗对鼻咽癌原发灶的作用。材料与方法１９９４年５月至１９９５年４月，９０例初治鼻咽癌病例分为热放组（腔内微波热疗＋放疗）与单放组（单纯放疗），同期配对分析，配对条件为年龄、性别、ＴＮＭ分期，根据治疗前后ＣＴ扫描评价近期疗效。两组均为常规连续放疗，剂量相同，热放组加用鼻咽腔内２４５０ＭＨｚ微波热疗，每周１～２次，每次加热６０分钟，肿瘤表面温度４１～５２℃。结果治疗后２～３个月ＣＴ复查热放组鼻咽癌原发灶肿瘤全消率６８．９％（３１／４５），单放组为４６．７％（２１／４５），Ｐ＜０．０５。肿瘤全消率与原发灶Ｔ分期、咽旁间隙受侵情况、肿瘤表面加热温度及热疗次数有关。结论腔内２４５０ＭＨｚ微波热疗配合放疗可提高鼻咽癌原发灶的近期肿瘤全消率。     

鼻咽癌合并皮肌炎远期疗效分析

鼻咽癌是常见恶性肿瘤之一,但是鼻咽癌合并皮肌炎者仅占0.023％。我院于1964年4月至1986年12月,共完成计划治疗者46例,现就用强的松作为补充治疗来配合放疗是否会影响该病的远期疗效问题进行分析探讨。 1 材料与方法 男29例,女17例,病理以低分化鳞癌占大多数为93.4％(43/46)。临床分期(长沙分期,1978年):Ⅰ期5例,Ⅱ期22例,Ⅲ期和Ⅳ期分别为14例及5例。 治疗方法: 46例全部采用分段放射治疗。并分为先用强的松1个月以上,然后放疗(P R组)21例、放疗与强的松     

腔内微波热疗合并放射治疗鼻咽癌的临床对照研究

１９９４年５月至１９９５年４月将９８例初治鼻咽癌配对分为腔内微波热疗合并放疗（简称热疗）组与单纯放疗（简称单放）组各４９例。间接鼻咽镜与ＣＴ近期疗效评价，热放组鼻咽原发灶完全消退率分别为９５．９２％与６８．８９％，单放组为８３．６７％与４６．６７％（Ｐ＜０．０５），热放组肿瘤缩小１／２与完全消退放射剂量均较单放组明显降低。疗效与加热温度，热疗次数有关，同时亦发现热放组颈淋巴结转移灶完全消退率较单放组高。     

鼻咽癌肺转移的姑息治疗

鼻咽癌放疗后远处转移发生率在20％～28．1％，远处转移最常见的部位是骨、肺、肝，其中肺转移的发生率约在4％～20％。通常的治疗方法是：单个肺转移灶可以作放疗与手术，多个肺转移病灶以化疗为主。本院1989～1996年治疗鼻咽癌肺转移病人47例，回顾性将其分为化疗组与单纯放疗组，比较临床疗效。     

Lung metastasis alone in nasopharyngeal carcinoma: a relatively favorable prognostic group. A study by the Hong Kong Nasopharyngeal Carcinoma Study Group

BACKGROUND: The current study was conducted to examine the pattern and the predictive factors of distant metastases (DM) in patients with nasopharyngeal carcinoma (NPC) after primary radiotherapy treatment. METHODS: Data from all five regional cancer centers in Hong Kong were collected retrospectively and pooled for the current study, which was coordinated by the Hong Kong Nasopharyngeal Carcinoma Study Group. The sample was comprised of all 2915 patients with NPC without DM at the time of presentation who were treated with radiotherapy in 1 of the 5 cancer centers during the period between January 1996 and December 2000. RESULTS: DM was found to be the leading cause of NPC failure, with a 5-year actuarial rate of 14.9% in this patient cohort. Despite the poor overall survival (OS) of these patients, those with lung metastasis alone represented a distinctive group associated with a significantly better OS. International Union Against Cancer (UICC) N classification, UICC T classification, advanced age, and male gender were found to be significant and independent determinants for DM. CONCLUSIONS: Long-term survival is possible in patients with distant metastatic NPC confined to the lung. An aggressive approach to treatment for this group of patients should be considered.     

早期鼻咽癌单纯调强放疗的远期疗效评价

目的 评价早期鼻咽癌各亚组根治性调强放疗(IMRT)的远期疗效和副反应.方法 回顾分析2001-2008年在本中心初诊接受IMRT的198例按UICC/AJCC2002分期的早期鼻咽癌的5年生存率、治疗失败因素和急性副反应.Kaplan-Meier法计算生存率并Logrank检验.结果 中位随访时间为50.9个月(12～104个月),随访率为96%,随访满1、3、5年者分别为198、139、72例.全组病例5年的肿瘤相关生存率、鼻咽局部无复发生存率及无远处转移生存率分别为97.3%、97.7%及97.8%.T1、T2期患者5年鼻咽局部无复发生存率分别为100%、96.7%(x2=2.24,P=0.135).T1N0、T2N0、T1N1和T2N1期的5年无远处转移生存率分别为100%、98.8%、100%和93.8%(x2=2.35,P=0.125).全组治疗5年总失败率仪为6.1%(12例)且全部为Ⅱb期患者.急性副反应主要是1、2级黏膜炎及咽喉炎,未发现放射性脑、脊髓病和脑神经损伤的晚期副反应.结论 IMRT早期鼻咽癌能取得较好疗效且治疗副反应轻微;但T2b和T2bN1期患者有相对较高的局部复发和远处转移趋势,也许对这些患者放化疗能进一步获益.

Abstract：

Objective To evaluate the outcomes and toxicities of early stage nasopharyngeal carcinoma(NPC)patients treated with intensity-modulated radiotherapy(IMRT)alone. Methods From February 2001 to January 2008, 198 early stage NPC patients according to AJCC/UICC 2002 staging system were treated by radical radiotherapy with IMRT technique in our institute, the clinical data were analyzed retrospectively. Results The 5-year disease-specific survival, local recurrence-free survival(LRFS)and distant metastasis-free survival(DMFS)were 97.3%, 97.7% and 97. 8% respectively. The 5-year LRFS for T1, T2 patients were 100%, 96. 7%(x2 = 2. 24 ,P = 0. 135)respectively. The 5-year DMFS for T1 N0,T2N0, T1N1, and T2N1 patients were 100%, 98. 8%, 100% and 93. 8%(x2= 2. 35, P= 0. 125)respectively. Grade 1 and 2 mucositis and pharyngitis were most common acute toxicities. Radiation encephalopathy and cranial nerve injury were not observed in all patients. Conclusions IMRT alone for early stage NPC patients can produce satisfactory results and acceptable treatment-relative toxicities. Patients with T2b and T2bN1 had a relatively higher incidence of local recurrence and distant metastasis, which suggested that combination of IMRT and chemotherapy may improve clinical results in those patients.     

104例初治鼻咽癌放疗的回顾性分析

目的：回顾性分析初治鼻咽癌的临床疗效和晚期损伤。方法：初治鼻咽癌患者104例,常规面颈联合野加中下颈切线野照射,鼻咽部剂量70-76Gy,中位剂量72Gy;肿大淋巴结60-70Gy,中位剂量66Gy;颈部预防剂量50Gy。62例患者接受了化疗。常规放疗后如鼻咽有肿瘤残留,则通过立体定向加量10-24Gy,颈部有淋巴结残留的观察3个月,如仍阳性行颈清扫术。生存率用Kaplan-Meier法计算,RTOG/EORTC标准评价晚期损伤。结果：中位随访时间43个月,5年局部区域控制率、无病生存率和总生存率分别为76.2%、62.8%、64.3%。I、II、Ⅲ、Ⅳa期的5年的总生存率分别为100%、86.3%、68.5%、50.2%,Ⅲ＋Ⅳa期的5年的总生存率为59.6%。共40例治疗后出现失败,失败率为38.5%,局部区域失败18例,远处转移22例,骨转移与肺转移居前两位。听力明显下降26例,占25%;味觉异常18例,占17.3%;1例出现放射性颞叶损伤;6例曾出现一过性低头触电感,未见其它放射性脊髓损伤。结论：本组鼻咽癌常规放疗5年总生存64.3%,无严重不良反应。     

Distant metastasis risk and patterns of nasopharyngeal carcinoma in the era of IMRT: long-term results and benefits of chemotherapy

Purpose: To report the distant metastasis (DM) risk and patterns for nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) and to analyze the benefits of chemotherapy based on DM risk.Materials and Methods: 576 NPC patients were analyzed. The DM rates were calculated using the Kaplan-Meier method, and the log-rank test was used to compare differences. The patients were divided into different risk subclassifications according to DM hazard ratios.Results: 91 patients developed DM after treatment, with bone as the most common metastatic sites. 82.4% of DMs occurred within 3 years of treatment. Patients were classified as low-risk, intermediate-risk and high-risk, and the corresponding 5-year DM rates were 5.1%, 13.1% and 32.4%, respectively (P < 0.001). Chemotherapy failed to decrease the DM rate in the low-risk subclassification, but decreased the DM risk in the intermediate-risk subclassification (P = 0.025). In the high-risk subclassificaiton, the DM rate was 31.9% though chemotherapy was used, which was significantly higher than that of other two subclassifications.Conclusions: DM is the dominant treatment failure in NPC treated by IMRT, with similar occurrence times and distributions to those that occurred in the era of conventional radiotherapy. Further studies on treatment optimization are needed in high-risk patients.     

Prediction for distant failure in patients with stage M0 nasopharyngeal carcinoma: the role of standardized uptake value

Distant failure is an important cause of death in stage M0 primary nasopharyngeal carcinoma (NPC). However, a reliable prognosticator for occurrence of distant failure was lacking. Thus, we conducted this study to investigate prospectively the role of standardized uptake value on 18F-FDG for predicting distant failure in stage M0 NPC. Patients with stage M0 primary NPC diagnosed by both conventional work-up (CWU) and 18F-FDG PET were enrolled. Survival was estimated by the Kaplan-Meier method. Cox proportional hazards models were used to identify independent prognosticators. Between January 2002 and July 2003, 65 NPC patients were investigated. Up to the date of analysis, 12 patients died and 13 patients experienced recurrences, among whom 9 had distant failures. The 5-year overall survival (OS), relapse-free survival (RFS), and distant relapse-free survival (DRFS) were 81.2%, 79.2%, 84.4%, respectively. In multivariate analysis, the following risk factors for poor prognosis were identified: T3-4 (p=0.033) for RFS; and maximal standardized uptake value (SUVmax) of the primary tumor > 12.0 (p=0.012), stage IVa-b (p=0.037), and N2-3 disease (p=0.04) for DRFS. The 5-year DRFS in stage IVa-b patients with SUVmax > 12.0 was significantly lower than that in stage I-III patients with SUVmax < or = 12 (p=0.0001). None of the patients in the latter group developed distant failure. In conclusion, a SUVmax > 12.0 of the primary tumor represents a "metabolic phenotype" for occurrence of distant failure in stage M0 NPC patients. And the combined information of SUVmax and tumor staging can guide the use of neoadjuvant/adjuvant therapy and surveillance protocols to improve distant control.     

362例早期鼻咽癌单纯放疗疗效分析

目的 分析早期鼻咽癌患者单纯放疗的长期疗效及不同T与N分期对预后影响.方法 搜集接受单纯放疗的362例早期(T1～T2 N0～1M0期,1992年福州分期)鼻咽癌初治患者的临床资料做回顾分析.结果 中位随访70个月,全组病例5年总生存率为85.0%.T1N0、T2N0和T1N1期5年总生存率分别为96.6%、91.3%和85.8%(χ2=3.83,P＞0.05),T2N1期的(73.1%)比前3个期别明显减低(χ2=30.0,P＜0.05),而4个期别的5年无局部复发生存率和无区域复发生存率均无差异.T1N0、T2N0和T1N1期5年无远处转移生存率分别为94.9%、97.5%和95.6%(χ2=0.53,P＞0.05),T2N1期的(81.2%)比前3个期的明显减低(χ2=26.6,P＜0.05).结论 单纯常规放疗对T1N0、T2N0和T1N1期患者可获得满意疗效.T2N1M0期的疗效明显差于前3个期别,其治疗失败的主要原因是远处转移.针对T2N1M0期筛选容易发生远处转移的个体给予放化综合治疗是下一步研究方向.     

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。     

高聚生瘤内注射在复发性鼻咽癌再放疗中的应用价值

目的：研究高聚生瘤体内注射配合放射治疗复发性鼻咽癌并颈部淋巴结转移的临床使用价值。方法：41例患者采用高聚生瘤体内注射联合肌注配合放射治疗、照射剂量DT65—70Gy／6．5—7周。观察其近、远期疗效、不良反应等。结果：治疗结束后鼻咽病灶41例中CR18例，占43．9％，PR17例，占41．5％，NC6例，占14．6％，PD室0例。总有效率（CR＋PR）为85．4％。颈部淋巴结肿块41例次，其中CR17例，占41．5％，PR19例，占46．3％，NC5例，占12．2％，PD0例。总有效率（CR＋PR）为87．8％。其中两处均出现CR的共有16例，占39．0％（16／41）。1年生存率为80．48％（33／41），2年生存率为62．50％（25／40），3年生存率为47．50％（19／40）。3年远处转移发生率为7．3％（3／41）。结论：高聚生瘤体内注射联合肌注，可使瘤体内该药物浓度增高，配合放射治疗、增强了对肿瘤细胞的直接杀伤作用，具有较高的肿瘤消退率、远期生存率并且改善了患者的生存质量。     

鼻咽癌新鲜肿瘤组织DNA倍体性与预后的关系

背景与目的:因肿瘤有生物学异质性,部分肿瘤的预后和TNM分期并不符合;寻找有效的生物学预后指标作为临床分期的补充,可为今后鼻咽癌的个体化治疗提供一个新的依据.本研究探讨初治鼻咽癌患者新鲜肿瘤组织细胞的DNA倍体性与疗效、预后的关系.方法:1999年1月至2000年2月,53例初治鼻咽癌患者进入本研究,其中单纯放疗32例,另21例患者于放疗第4周接受了一个疗程的PF方案化疗.患者治疗前均活检取新鲜肿瘤组织,用流式细胞仪进行DNA倍体检测.结果:53例患者中,二倍体32例(60.4%),异倍体21例(39.6%).不同倍体组患者的年龄、性别、临床分期、N分期、化疗与否的差异无统计学意义(P=0.695、0.657、0.088、0.972和0.335).全组患者中位随访时间73个月(12～84个月).全组5年总生存率65.61%,其中二倍体组为80.92%,异倍体组为42.86%(P=0.002);5年无远处转移生存率二倍体组为84.26%,异倍体组为44.53%(P=0.003);5年无复发生存率二倍体组为92.59%,异倍体组为72.65%(P=0.118).单因素分析结果显示,临床分期是无复发生存率的影响因素,DNA倍体性、临床分期和T分期是总生存率和无远处转移生存率的影响因素.多因素分析结果显示,与总生存率相关的独立预后因素为DNA倍体性(P=0.020)和临床分期(P=0.007),与无转移生存率相关的预后因素亦为DNA倍体性(P=0.017)和临床分期(P=0.011).结论:采用流式细胞术检测新鲜组织细胞的DNA倍体性和临床分期一样可以预测鼻咽癌患者的预后;DNA异倍体患者比二倍体患者更容易出现远处转移而导致治疗失败.