后程逐步递量加速超分割放射治疗局部晚期鼻咽癌的疗效分析

目的:观察后程逐步递量加速超分割治疗局部晚期鼻咽癌的近期疗效及毒副反应。方法:72例T3-4N0-1M0期鼻咽癌随机分为常规分割放疗组(对照组)及后程逐步递量加速超分割放疗组(研究组),每组各36例。对照组照射2Gy/次,5次/周,鼻咽部原发灶DT68-72 Gy/6.8-7.2周,颈部转移灶DT60-70 Gy/6-7周,预防照射DT50 Gy/5周。研究组前3.6周同对照组,然后每周分割剂量逐渐递增,即分割剂量的第1、2、3周分别为1.1Gy/次、1.2 Gy/次、1.3 Gy/次,每天2次,两次间隔时间大于6小时,每周5次,鼻咽部总剂量DT72Gy/6.6周,颈部转移灶DT60-70 Gy/6-7周,预防剂量DT50 Gy/5周。结果:放疗结束后3个月,研究组和对照组原发灶CR、PR率分别为77.8%、22.2%和55.6%、44.4%(P<0.05),两组有显著性差异,研究组急性放射性反应高于对照组,但是无统计学意义(P>0.05)。结论:后程逐步递量加速超分割放疗能提高局部晚期鼻咽癌的近期疗效,急性放射性反应患者可以耐受,远期疗效和后期放射损伤有待进一步随诊观察。

Late Course Escalated Hyperfractionated Accelerated Radiation Therapy for Regional Advanced Nasopharyngeal Carcinoma

Objective:To observe the immediate responses and side effect in late course escalated hyperfractionated nasopharyngeal accelerated radiation therapy for regional advanced carcionoma(NPC).Methods:A total of 72 patients with stage T3-4N0-1M0 nasophyaryngeal carcinomas were randomized into two groups,the conventional fractionation group(control group) and the late course escalated hyperfructionated accelerated radiation therapy group(study group).Thirty-six cases were assigned to each group.The patients in control group were treated by 2Gy daily,5days per week,the total doses for nasopharyngeal carcinoma and the neck were 68-72Gy and 66-70Gy respectively,a preventive dose with 50Gy in the neck.The patients in the study group were treated with the same fractionantion as those in the control group to the dose of 36Gy.And then followed by a late course accelerated escalated hyperfractionated accelerated radiation therapy.The patients in study group were treated by escalated dose:1.1Gy,1.2Gy,1.3Gy,1st to 3rd weeks,respectively.The total dose of nasopharyneal carcinoma was 72Gy.Results:Three months after finishing the radiotherapy,the CR and PR rates of primary lesions were 77.8% and 22.2% respetively in the study group and 55.6% and 44.4%,respectively in the control group(P<0.05).There was significant difference between the two groups.The acute radiation reaction was higher in the study group than that in the control group,however,there was no significant difference between the two groups(P>0.05).Conclusion:The results of this study showed that late course escalated hyperfractionated accelerated radiation therapy could provide promote immediate response in regional advanced nasopharyngeal carcinoma.The survival rate and late complications in the long term were worthy of further study.