鼻咽癌调强放疗与适形放疗的疗效和副反应比较研究

目的：比较鼻咽癌患者调强放疗与适形放疗的疗效和副反应，以及对预后和生存质量的影响。方法2005年1月至2007年10月，我院共186例初诊且无远处转移的鼻咽癌患者接受全程放射治疗，调强放疗组89例，适形放疗组97例，两组病例均采用Phicips高能直线加速器治疗，选择能量为6MV-X射线。适形放疗组分4段设野，DT2Gy/次，1次/d ，5次/周，根治剂量DT70～72Gy/35～36次/7～8周，预防剂量DT50Gy/25次/5周。调强放疗采用7野共面照射，靶区处方剂量GTVnx ：69．96Gy～73．92Gy ，GTVnd：69．96Gy ，PTV1：60．06Gy ，PTV2：50．96Gy。全疗程33次，1次/d ，5次/周。放疗过程中每两周执行1次实时验证。结果两组病例均顺利完成全程放疗，适形放疗组5年局部控制率、总生存率分别为90．7％、85．5％；调强放疗组5年局部控制率、总生存率分别为91％、86．5％。调强放疗组口干和张口困难发生率和损伤程度明显低于适形放疗组。结论调强放疗组的副反应发生率和发生程度较适形放疗组明显降低，能提高鼻咽癌患者生活质量。

Study on the compared with the conformal radiotherapy curative effect and adverse reaction of inten-sity-modulated radiotherapy for nasopharyngeal carcinoma

Objective To compare with efficacy ,side effects ,the prognosis and quality of life in patients of nasopharynx cancer treated with intensity-modulated radiation therapy （IMRT ） and three-dimensional conformal radiation therapy （3-DCRT ） .Methods 186 patients with newly diagnosed pa-tients of nasopharynx cancer without distant metastasis were treated with radiation therapy in our hos-pital from January 2005 to October 2007 .The patients were divided into two group which were inten-sity-modulated radiation therapy group （89 cases） and conformal radiotherapy group （97 cases） .The patients were treated with Phicips high-energy linear accelerator with 6 MV X rays .The patients in 3-DCRT group were treated with four-field （10Gy ,70-72Gy or 50Gy ） .Coplanar beams of intensity modulated radiation therapy to be used was 7 （GTVnx ：69 .96Gy~73 .92Gy ,GTVnd：69 .96Gy ,PTV1 ：60 .06Gy ,PTV2 ：50 .96Gy ,33 numbers ,five times a week） .Results The two groups of patients were successfully complete radiotherapy .And the conformal radiotherapy group of 5-year local control rate , and overall survival rates were 90 .7% and 85 .5% .The 5-year local control rate ,overall survival rate were 91% and 86 .5% .The incidence of xerostomia and trismus ,and oral injuries in IMRT group was significantly lower than the group of conformal radiotherapy .Conclusion The incidence and degree of side effects in IMRT group was significantly lower than 3-DCRT group ,IMRT can improve the quali-ty of life of patients with nasopharyngeal carcinoma .