鼻咽癌单纯常规外照射放疗疗效观察

目的分析35例初治鼻咽癌单纯常规外照射的临床效果，探讨提高疗效的临床因素。方法对我院2003年全年35例初治鼻咽癌单纯常规外照射疗效进行回顾分析。全部病例均根据CT和MRI对照射靶区进行个体化设计，按规范化要求制定治疗计划。采用铅挡块、面颈联合野等中心照射技术。鼻咽癌根治剂量68～70Gy／7周，颈淋巴结阳性者颈部根治剂量60～70Gy／6～7周，阴性者给与预防剂量50Gy／5周。结果全组病例1、2、3、4年总生存率分别为89．5％、81．9％、78．1％和75．7％；无瘤生存率分别为80．8％、73．1％、68．5％和65．1％；无转移生存率分别为84．0％、77．2％、74．4％和72．0％；无复发生存率分别为95．5％、92．7％、90．3％和87．3％。全组病例放疗结束总残存率为14．6％，4年复发率为7．2％，远处转移率为9．2％，放疗后的总失败率为30．9％。中位复发时间为放疗后19．3个月，中位转移时间为放疗后12．8个月。结论采用CT和MRI进行照射靶区的个体化设计，改进照射技术，缩短总疗程时间，提高照射剂量，加强放疗全过程的质量控制与质量保证，有助于提高鼻咽癌常规放了得疗效。

Retrospective Analysis of 35 Nasopharyngeal Carcinoma Patients Treated with Conventional External Beam Radiotherapy Alone

Objective To analyze the clinical outcome of 35 primary nasopharyngeal carcinoma patients treated with conventional external beam radiotherapy alone. Methods 35 patients were treated from Jan. 1 to Dee. 31 in 2003. The radiation fields were delineated according to the CT/MRI imaging findings on disease extent. Two lateral opposing isocentric portals with customized blockings were used for the nasopharynx and upper neck. The dose delivered to tumor in the nasopharynx was 68 - 70 Gy in 7 weeks. The doses delivered to the neck was 60 - 70 Gy in 6 ~ 7 weeks for patients with positive lymph nodes and 50 Gy in 5 weeks for the patients with negative lymph node. Results The 1,2,3 and 4 years overall survival rate （OS） was 89. 5 %, 81.9% ,78. 1% and 75.7%, and metastasis - free survival rate （MFS） was 84. 0% ,77.2% ,74. 4% and 72.0% ,respectively. The 1,2,3 and 4 years disease-free survival rate（DFS） was 80. 8% ,73.1% ,68.5% and 65.1% ,and the relapse-free survival rate（RFS） was 95.5% ,92. 7% ,90. 3% and 87.3% ,respectively. The overall failure rate was 30.9%. At the end of the radiotherapeutic course,the percentage of residual disease was 14.6%. The 4 - year loco regional recurrence and distant metastasis rates after radiotherapy wdre 7.2% and 9. 2% with a median time of 19. 3 months and 12. 8 months. Conclusion It may be helpful to improve radiotherapy curative effect when the target is individually designed through improving irradiation technique according to CT/MRI findings and by shorten the overall course time, enhancing irradiation dose and strictly implementing QA/QC measures.