鼻咽癌面颈联合野配合后程超分割放疗疗效分析

目的 观察后程超分割治疗鼻咽癌的疗效及毒副反应。方法 93例鼻咽癌患者被随机分为后程超分割治疗组（后超组47例）和常规分割对照组（常规组46例）。均先行面颈联合野常规分割对穿照射Dr36Gy，20分次，4周，后超组缩野改用后程超分割照射，1．15～1．20Cy／次，2次／d，两次间隔时间6，8h，5d／周，鼻咽病灶总Dr74．8～76．7Gy，54分次，7．5周完成。对照组缩野后常规照射2．0Gy／次，1次／d，鼻咽灶总D169～72Gy，37～38分次，7．5周完成。颈部均为常规照射。结果 后超组和常规组鼻咽部肿瘤消退率分别为100％、96％（X^2=2．10，P〉0．05）；1、3、5年肿瘤局部控制率分别为100％、98％、86％和100％、86％、54％（X^2=10．90，P〈0．01）；1、3、5年生存率分别为100％、94％、85％和98％、84％、63％（X^2=8．70，P〈0．01）。两组放疗口腔黏膜反应无差别（X^2=1．00，P=0．800）。后超组复发率低于常规组（11％：30％；X^2=5．60，P〈0．05），而转移率无差别（12．8％：28．3％；X^2=3．40，P〉0．05）。结论 鼻咽癌后程超分割的局部控制率及长期生存率明显高于常规组，而急性毒性反应及复发转移无明显差别。

Nasopharyngeal carcinoma treated with facial cervical portal and late-course hyperfractionation radiotherapy

Objective To evaluate the clinical results and side reactions of nasopharyngeal carcinoma(NPC) treated with facial cervical portal and late-course hyperfractionation radiotherapy. Methods From July 1996 to December 1997, 93 NPC patients were divided into conventional fractionation and hyperfractionation radiotherapy groups. In 47 patients, facial cervical portal was used until the dose of 36Gy/20 fraction in 4 weeks, and then followed by hyperfractionation radiotherapy:1.15-1.2Gy/fraction, 2 fraction/day, with 6-8 hour interval between, to a total dose of 74.2-76.7Gy in 7.5 weeks without changing the shape of the portal. Forty-six patients were treated by conventional radiotherapy:2.0Gy/fraction ,5 fraction/week, to a total dose of 69-72Gy in 7.5 weeks. Results The regression rate was 100%,96% in hyperfractionation and conventional fractionation radiotherapy group after 6 months of radiotherapy, respectively. The 1-,3-,and 5-year local control rate was 100%,98%,86% in the hyperfractionation radiotherapy group and 98%,86%,54% in the conventional fractionation group(P<0.01). The 1-,3-,and 5-year survival rate was 100%, 94%, 85% in the hyperfractionation radiotherapy group and 98%, 84%, 63% in conventional fractionation(P<0.01). Difference in acute mucusitis and late complications was not significant(P>0.05).Conclusions In nasopharyngeal carcinoma ,the local control rate and survival rate are raised by hyperfractionation radiotherapy. But recurrence rate and distant metastasis rate are not significantly different.