大分割三维适形放疗治疗鼻咽癌鼻咽复发再程放疗的不良反应及疗效评估

目的 研究大分割三维适形放疗治疗鼻咽复发鼻咽癌,了解相关放射损伤反应及疗效。方法 回顾分析我院2008-2013年间收治的鼻咽复发鼻咽癌患者153例,采用大分割三维适形放疗(3 Gy/次,5 次/周,总量51~60 Gy,4周共17~20次),观察近期和远期损伤、KPS评分、近期和远期疗效。结果 近期损伤中口腔黏膜、乏力治疗前与治疗结束时相比不同(P均<0.05),远期放射损伤发生率分别为口干(95.4%)、耳聋(51.0%)、张口困难(79.1%)、颌面部纤维化(33.3%)、放射性脑病(15.0%),治疗前与治疗结束时相比不同(P均<0.05),实际远期放射损伤口干(91.5%)、耳聋(50.9%)、张口困难(76.5%)、颌面部纤维化(32.0%)、放射性脑病(14.4%);治疗结束时与治疗后3个月对比患者KPS评分变化人数不同(P<0.05);治疗后1、3、6、9、12个月后局部控制率分别为29.4%、68.6%、79.1%、83.7%、86.9%,1个月后与3个月后、3个月后与6个月后对比不同(P<0.05);1、2、3、4、5年生存率分别为96.1%、80.4%、68.5%、57.9%、51.1%。结论 大分割三维适形放疗用于鼻咽复发鼻咽癌患者的近期疗效、远期疗效较好,局部控制率高,患者可耐受,安全性较好。

Clinical efficacy and safety of hypofractionated three-dimensional conformal radiotherapy in the treatment of recurrent nasopharyngeal carcinoma

Objective To evaluate the clinical efficacy and safety of the hypofractionated three-dimensional conformal radiotherapy in the treatment of recurrent nasopharyngeal carcinoma. Methods Clinical data of 153 patients with recurrent nasopharyngeal carcinoma admitted to our hospital from 2008 to 2013 undergoing hypofractionated three-dimensional conformal radiotherapy (3 Gy for each time, 5 times a week, a total dose of 51-60 Gy, 17-20 times/4 weeks) were retrospectively analyzed. The short-and long-term radiation-induced injury, Karnofsky performance score (KPS), short-and long-term clinical efficacy were evaluated. Results For the short-term radiation-induced injury, the incidence of oral mucosa and fatigue significantly differed before and after treatment (both P<0.05). Regarding the long-term radiation-induced injury, the incidence of dry mouth (95.4%) and deafness (51.0%),difficulty in opening mouth (79.1%),maxillofacial fibrosis (33.3%) and radiation-induced encephalopathy (15.0%) significantly differed before and following treatment (all P<0.05). The actual long-term radiation-induced injury included dry mouth (91.5%), deafness (50.9%), difficulty in opening mouth (76.5%), maxillofacial fibrosis (32.0%) and radiation-induced encephalopathy (14.4%). The number of patients with changes in the KPS scores significantly differed between the end of treatment and 3 months after treatment (P<0.05). The local control rates were 29.4%, 68.6%, 79.1%, 83.7% and 86.9% at 1-, 3-, 6-, 9-and 12-month after corresponding treatment, respectively. The local control rate significantly differed between 1 and 3 months, and between 3 and 6 months after treatment (both P<0.05). The 1-, 2-, 3-, 4-and 5-year survival rates were calculated as 96.1%,80.4%,68.5%,57.9% and 51.1%,respectively. Conclusions Hypofractionated three-dimensional conformal radiotherapy is an efficacious and safe treatment of recurrent nasopharyngeal nasopharyngeal carcinoma, which yields relatively high short-and long-term clinical efficacy, high local control rate and well tolerance by the patients.