分次立体定向放疗鼻咽癌初治残存病灶的远期疗效观察

目的 回顾分析分次立体定向放疗(FSRT)鼻咽癌放疗后残存肿瘤的长期疗效,评价其临床价值.方法 对46例鼻咽癌放疗后鼻咽局部残存患者采用分次立体定向放疗技术推量治疗.根据1992年福州分期,Ⅰ、Ⅱ、Ⅲ、Ⅳa期分别为1、6、30、9例,T1、T2、T3、T4期分别为3、11、27、5例,N0、N1、N2、N3期分别为14、16、12、4例.常规分割鼻咽DT68～70 Gy 7～8周完成,Ⅲ、Ⅳa期患者加用PVF或POF方案在放疗前后各化疗1个周期.对鼻咽残存病灶FSRT总剂量18～24 Gy,分3次,间隔3～7 d,1～3个中心,70%～90%参考剂量曲线.结果 61%完全缓解,39%部分缓解.1、2、3、4、5年总生存率分别为100%、87%、83%、78%、76%.1、3、5年无瘤生存生存率分别为100%、93%、89%.1、3、5年无远处转移生存率分别为100%、85%、79%.1、3、5年局部控制率分别为100%、94%、91%.死亡17例,1例死于颈部淋巴结复发,2例死于鼻咽大出血,4例死于鼻咽局部复发,10例死于远处转移.结论 FSRT鼻咽癌放疗后残存病灶局部控制率高、远期疗效好且并发症少,可成为鼻咽癌综合治疗手段之一.单次剂量和总剂量还需进一步研究.

Evaluation of fractionated stereotactic radiotherapy for residual lesion after the first course of radiotherapy for nasopharyngeal carcinoma

Objective To analyze the long-term results of fractionated stereotactie radiotherapy(FSRT)for the local residual lesion after the first course of radiotherapy for nasopharyngeal carcinoma.Methods From July 1997 to July 2002,46 patients were treated with FSRT.According to the 1992 Fuzhou staging system,the number of patients was 1,6,30 and 9 with stage Ⅰ,Ⅱ,Ⅲ and Ⅳ disease,respectirely;3,11,27 and 5 with T1,T2,T3 and T4 tumor,respectively;14,16,12 and 4 with N0,N1,N2and N3 disease.Radiotherapy was delivered to tumors with the total of dose 68-70 Gy in 7-8w.Chemotherapy(2 cycles of PVF or POF)was given to the patients with stage Ⅲ and Ⅳ a disease.FSRT was given to the residual disease with the total dose of 18-24 Gy in 3 fractions with an interval of 3-7 days.The reference dose line was 70%-90%.Resuits CR and PR rates in this group were 61%and 39%,respectively.The overall survival rates of each year from 1- to 5-year were 100%,87%,83%,78%and 76%.The 1-,3- and 5-year disease-free survival rates were 100%,93%and 89%;The distant metastasis-free survival rates were 100%,85%and 79%;The local-regional control survival rates were 100%,94%and 91%.Seventeen patients who died during the follow-up period were 1 for local cervical lymph node recurrence,2 for fatal nasopharyngeal hemorrhage,4 for local nasopharynx recurrence,and 10 for distance metastases. Conclusions Fraetionated stereotactic radiotherapy is safe and effective for the patients with residual lesion of nasopharyngeal carcinoma at the primary site after radiotherapy.The optimized fractionation and total dose requires the further investigation.