螺旋断层放疗治疗鼻咽癌失败病例分析

摘要：目的总结分析我院螺旋断层放疗治疗鼻咽癌36例失败病例的临床经验。方法2007年9月--2012年8月间共初治鼻咽癌217例，治疗失败36例（Ⅰ期1例、Ⅱ期5例、Ⅲ期16例、Ⅳ期14例），其中单纯放疗9例，同步综合治疗27例。结果中位随访时间27（6～57）个月，中位失败时间12（3～42）个月，局部复发10例（Ⅰ期1例、Ⅱ期1例、Ⅲ期5例、IVa期3例），照射野内复发7例，照射野边缘复发3例；区域复发3例（Ⅲ期2例、Ⅳa期1例），远处转移16例（Ⅱ期3例、Ⅲ期7例、Ⅳa期6例），5例骨转移，5例肝转移，1例髓内转移，5例多器官转移；其他因素失败7例。死亡29例（80．6％），包括局部复发7例，区域复发2例，远处转移13例，不明原因咽部出血5例，急性脑疝1例，全身虚弱衰竭1例。结论螺旋断层放疗治疗鼻咽癌失败主要原因为复发及转移，建议原发肿瘤GTV外扩5mm边界并每日行图像引导；针对N。的Ⅱ期患者放疗联合含铂化疗可以有效降低治疗失败率；治疗失败后患者可从挽救治疗中获益。

Failure of helical tomotherapy in treatment of patients with nasopharyngeal carcinoma

Objective To analyze the failure of helical tomotherapy （TOMO） in treatment of 36 patients with nasopharyngeal carcinoma （NPC）. Methods Of the 217 NPC patients admitted to our hospital from September 2007 to August 2012, 36 failed to helical TOMO （including 1 at stage I , 5 at stage II , 16 at stage Ⅲ, and 14 at stage IV ）. Of these 36 patients, 9 received simple radiotherapy and 27 received synchronization radiotherapy. Results The median follow-up time was 27 months （6 - 57 months）. The median failure time was 12 months （3 -42 months）. Of the 10 patients with local recurrence （including 1 at stage I , I at stage II , 5 at stage III, and 3 at stage IV a）, 7 had recurrence in the irradiation field and 3 had recurrence in the irradiation field margin. Three patients had regional recurrence （including 2 at stage III and 1 at stage IV a）. Of the 16 patients with distant metastases （including 3 at stage Ⅱ , 7 at stage Ⅲ , and 6 at stage IV a）, 5 had bone metastasis, 5 had liver metastasis, 1 had intramedullary metastasis and 5 had multiple organ metastasis. Seven patients failed to the treatment due to other reasons. Twenty-nine patients died with a death rate of 80.6%. Of these 29 patients, 7 died of local recurrence, 2 died of regional recurrence, 13 died of distant metastasis, 5 died of pharyngeal bleeding with unknown reasons, 1 died of cerebral hernia, and 1 died of systematic failure. Conclusion Recurrence and metastasis are the main reasons for the failure of helical TOMO in treatment of NPC patients. Extension of 5 mm margin of GTV under image guidance is suggested for primary NPC. Radiotherapy in combination with platinum chemotherapy can reduce the failure rate in NPC patients at stage I/ who fail to helical TOMO.