255例初治鼻咽癌调强适形放疗临床观察

目的探讨调强适形放疗(IMRT)治疗初治鼻咽癌的临床疗效。方法对255例初治鼻咽癌患者给予IMRT,将照射靶体积划分为鼻咽原发灶肿瘤区(GTVnx)、颈部转移淋巴结肿瘤区(GTVnd)、临床靶区1(CTV1)及2(CTV2),平均剂量分别为78.4、65.8、67.7、61.4Gy。其中172例接受了诱导化疗加同期化疗。结果中位随访时间19个月,1、2、3年总体生存率分别为100.0%、96.1%、95.7%。1、2、3年局部控制率分别为96.8%、94.5%、94.5%。1、2、3年无远处转移生存率分别为91.4%、87.8%、85.5%。单因素分析显示年龄、临床分期、T分期、N分期对生存的影响差异有统计学意义(P<0.05),病理分类对生存的影响差异无统计学意义(P>0.05)。多因素分析显示仅年龄、N分期与预后关系密切(P<0.05)。结论 IMRT技术对初治鼻咽癌病例均可获得理想的剂量分布,正常组织得到很好的保护。不良反应可以耐受,临床疗效令人满意。

Clinical observation of IMRT in 255 of primitive nasopharyngeal carcinoma

Objective To analyse the clinical efficacy of intensity modulated radiation therapy(IMRT) for primitive nasopharyngeal carcinoma(NPC).Methods 255 of primitive NPC received IMRT.The target volumes were divided into the gross tumor volume of nasopharynx(GTVnx),the gross tumor volume of positive cervical lymph node(GTVnd),the first clinical target volume(CTV1),and the second clinical target volume(CTV2).The average doses were 78.4Gy,65.8Gy,67.7Gy and 61.4Gy respectively.Among them,172 cases received induction chemotherapy plus concurrent chemoradiotherapy.The survival differences were compared by Kaplan-Merier method,Log-rank test and Cox multivariate regression analysis.Results The median follow-up interval was 19 months.The 1-year,2-year and 3-year overall survival rate were 100%,96.1% and 95.7%,the local-regional control rates were 96.8%,94.5% and 94.5%,the distant metastasis-free survival rate were 91.4%,87.8% and 85.5%,respectively.The univariate analysis showed that the four prognostic factors included age,clinical stage,T stage,N stage had statistical significance to the influence on survival,but the pathological classification had no statistical significance to the influence on survival.The multivariate analysis only identified two prognostic factors: age and N stage.Conclusion For primitive NPC,IMRT could lead to ideal dose distributions,the surrounding normal tissue are well protected with acceptable toxic and side effects.The clinical results are satisfactory.