鼻咽癌咽旁受侵不同射野放射治疗长期疗效比较

目的评价鼻咽癌咽旁受侵不同射野放射治疗的长期疗效。方法从１９８８年３月至１９９２年３月,经ＣＴ诊断鼻咽癌咽旁受侵的病人１０１例。所有病人均经病理确诊,被随机分为２个组。一组采用面颈联合野,另一组采用双耳前野加面前野。鼻咽部外照射总肿瘤量均为ＤＴ６８～７２Ｇｙ,照射３４～３６次,６８～７２周。所有病例均随访５年以上。生存曲线按寿命表法计算后绘制,经ｌｏｇ－ｒａｎｋ检验。结果２个组生存曲线比较：面颈联合野组高于非面颈联合野组（Ｐ〈０．０５）;无复发生存曲线比较：面颈联合野组显著高于非面颈联合野组（Ｐ〈００１）。咽旁茎突后区受侵,面颈联合野放射治疗的生存曲线明显高于非面颈联合野（Ｐ〉００５）;单纯茎突前区受侵的病人,面颈联合野与非面颈联合野放射治疗的生存曲线差异无显著意义（Ｐ〉００５）。非面颈联合野组发生１例放射性颈脊髓损伤,２个组急性和慢性放射损伤差异无显著意义。结论对鼻咽癌咽旁受侵的病人宜选用面颈联合野放射治疗。

Comprison of the long-term results between two radiotherapeutic protocols for nasopharyngeal carcinoma patients with involvement of the parapharyngeal space

Objective To evaluate the radiotherapy effects of nasopharyngeal carcinoma(NPC)with involvement of parapharyngeal space treated by different protocols. Methods 101 NPC patients with involvement of parapharyngeal space as assessed by CT scan were randomly divided from March 1988 to March 1992 into two groups (groups A and B). The patients in group A were treated with lateral faciocervical portals. The patients in group B were treated with preauricular portals plus nose portals. Diagnosis in all cases was confirmed by pathology. The median age was 45(2471) years. They were staged by the method of UICC 1997 system. Survival curve was obtained by lifetable calculation and logrank test. Results After treatment, the primary tumor disappearanAuthor ce rates for groups A and B were 17.4%(8/46)and 9.1%(5/55),local recurrence rates were23.9%(10/46) and 40.0%(22/55),disease-free 5-year survival rates were 47.8%(22/46) and 30.9%(17/55),respectively, Survival curve in group A was higher than in group B(P<0.05).Survival curve in group A for retro-styloid involvement was higher than in group B(P<0.01). But,the survival curve for NPC with involvement of Prestyloid parapharyngeal space in group A was no different from that of group B(P>0.05). The disease-free survival curve in group A was higher than group B(P<0.005). Conclusions The postradiation survival rate in NPC patients with parapharyngeal involvement is improved by the use of faciocervical portals without inflicting more radiation reactions or late-damages. It is suggested that NPC patients with parapharyngeal involvement be preferably treated by faciocervival portals.