后程加速超分割放射治疗I～II期鼻咽癌的疗效观察

目的：观察后程加速超分割放射治疗早期鼻咽癌的临床疗效、毒副反应及后遗症。方法：将108例I～II期鼻咽癌患者随机分为常规分割放疗组(常规组)和后程加速超分割放疗组(后超组)，每组54例。常规组照射2Gy/次，5次/周,总量为70Gy/7周。后超组前3.5周照射同常规组，然后开始1.5Gy/次，2次/日，间隔6h，总量为69Gy/6周。结果：鼻咽部肿瘤消退率：常规组为70.97％(22/31)，后超组为89.47％(34/38)，但两组差别无显著性意义(P=0.05)；颈部淋巴结完全消退率：常规组为86.67％(26/30)，后超组为90.91％(30/33)，两组差别无显著性意义(P>0.05)；两组1、2、3年生存率分别为96.12％、80.97％、78.55％和98.13％、93.95％、90.87％(P=0.06)，无明显的统计学差异；两组放疗毒副反应及后遗症也无显著性差别(P>0.05)。结论：I～II期鼻咽癌后程加速超分割放疗疗效未见优于常规分割放疗，但未加重放疗毒副反应及增加放疗后遗症，有必要扩大病例并作长期随访研究。

Treatment of Stage I- II Nasopharyngeal Carcinoma with Late Course Accelerated Hyperfractionation Radiotherapy

Objective: The current study was designed to observe the clinical results of late course accelerated hyperfractionation(LCAH) radiotherapy in Stage I- II nasopharyngeal carcinoma(NPC) patients. Methods: A total of 108 patients with Stage I- II NPC were divided at random into two groups: conventional fractionation(CF) and LCAH, The patients in CF group received a fraction of 2 Gy daily, 5 days per week, to total dose of 70 Gy/7weeks. The patients in LCAH group were treated with the same fractionation as CF group to dose of 36- 40 Gy, and followed by late course accelerated hyperfractionation radiotherapy: 1.5 Gy, twice daily, with the interval of 6 hours between fractions, to total dose of 69 Gy/6weeks. Results: The complete response rate in the nasopharynx was 89.47％ in the LCAHR and 70.97％ in the CFR at the end of the course (P=0.05). Disappeared rate of cervical lesion was not significant different between two groups (P >0.05). The survival rates of 1, 2, and 3-year were 98.13％ ,93.95％ ,90.87％ in the LCAH and 96.12％ ,80.97％ ,78.55％ in the CF, respectively (P=0.06). There was no significant difference in radiation reaction and sequela between two groups( P >0.05) . Conclusion: The clinical results of LCAH radiotherapy in Stage I- II NPC may be better than conventional fractionation radiotherapy, is worth further study.