鼻咽癌诊断和放射治疗的历史变迁

放射治疗是鼻咽癌最主要的治疗方法,回顾鼻咽癌放射治疗的百年历史,鼻咽癌的疗效逐步提高,尤其是近20年,疗效提高显著.在诊断方面,MRI逐渐取代CT成为鼻咽癌的标准影像学检查手段,使我们能更准确地评估鼻咽癌病灶范围,功能性影像技术的应用进一步提高了N分期和M分期的准确性并预测治疗后的近期、远期疗效,为制定个体化治疗方案提供依据;在放射治疗技术方面,60Co治疗机的问世使鼻咽癌的疗效较千伏X线机年代明显提高,相对于常规放射治疗,调强放射技术不仅进一步提高了疗效,更改善了患者的生存质量,是肿瘤放射治疗史上的一次重大变革;在放射生物学方面,鼻咽癌的非常规分割放射研究则未获突破性的成果;在综合治疗方面,鼻咽癌的综合治疗研究经历了序贯化疗到同期化疗,最终确定同期放化疗作为鼻咽癌的标准治疗.本文将从临床的角度回顾鼻咽癌疗效提高的历史进程.

The historical evolution Of diagnosis and radiotherapy for nasopharyngeal carcinoma

Radiation therapy is the mainstay treatment modality of nasopharyngeal carcinoma (NPC). The treatment outcome of NPC using external beam radiotherapy has been substantially improved over the past several decades. MRI has demonstrated remarkable advantage in detecting the extent of the primary tumor, and has replaced CT scan as the primary imaging modality for both diagnosis and staging for NPC. Functional imaging may further allow more precise staging of the disease and prediction of the treatment outcome. The introduction of Cobalt-60 has substantially improved the treatment outcome for NPC as compared to that in the era of Kilo-Voltage X-ray. And intensity-modulated radiation therapy (IMRT) not only improved the prognosis after treatment as compared to conventional radiotherapy, but also improved the quality of life. In addition, concurrent chemoradiation therapy has been extensively studied and become the standard treatment for locally and/or regionally advanced NPC. However,progress in radiation biology and its clinical application was not observed. This article presented a comprehensive review of the historical evolution of the diagnostic and therapeutic technologies and techniques for the management of NPC.