鼻咽癌放疗后长期生存者晚期副反应研究

目的 观察分析放疗后长期生存的鼻咽癌患者的晚期副反应情况.方法 对门诊随访的336例鼻咽癌患者进行调查,随访的中位时间为14年（5～38年）.鼻咽原发灶首程放疗中位剂量为70Gy（55～86Gy）.二程放疗18例,三程放疗1例.颈部根治性照射的中位剂量为64Gy（46～72Gy）,预防照射的中位剂量为55Gy（21～67Gy）.合并化疗的共48例.结果 根据1995年SOMA标准评价放疗晚期副反应,其中神经系统损伤109例,放射性脑损伤4例,放射性脊髓损伤1例（截瘫）,另有32例出现Lhermitte＇s征.颅神经损伤107例,其中前组的22例,后组的57例,同时的28例.Ka-plan-Meier法统计的颅神经损伤的5、10年累积发生率分别为11%、23%,颅神经损伤发生于放疗后5、＞5～10、＞10～15、＞15～20年的分别占11%、12%、14%、10%.3、4级放射性皮肤、肌肉/软组织反应、黏膜反应分别为55、79、36例.严重口干、张口困难分别为79、11例.320例出现放射性龋齿,192例全口龋齿.下颌骨骨髓炎2例.225例出现不同程度的听力下降,336例共672个侧耳中194个侧耳存在严重听力下降.总副反应发生率为84.5%.结论 放疗后长期生存的84.5%鼻咽癌患者存在不同程度的晚期副反应,部分患者存在严重的生活质量问题.颅神经损伤并不少见,可发生于放疗后的任一时间段,且不随生存时间的延长而趋于停止.

Late side reactions of long-term survivors after radiotherapy for nasopharyngeal carcinoma

Objective To observe the late side reactions in nasopharyngeal carcinoma patients who survived long after radiotherapy Methods 336 patients were evaluated. The median follow-up time was 14 years (range, 5-38 years). The nasopharyngeal region was given radiotherapy with a median of 70Gy (range,55-86Gy) in one course. Eighteen patients had re-irradiation for local recurrence. One patient treated by radiotherapy in three courses. The neck with lymph node metastasis was given radical radiotherapy with a median of 64Gy(range,46-72Gy). Node-negative neck was given prophylatic radiotherapy with a median of 55Gy(range,21-67Gy). Forty-eight patients were given chemotherapy. Results According to 1995 SOMA criterion to evaluate the late side reactions for nasopharyngeal carcinoma patients, 109 patients had neurological injuries,4 patients had brain injuries,and 1 patient had spinal cord injury. Among 107 patients with cranial nerve injuries: the 5- and 10-year cumulative occurrence rate was 11% and 23% respectively; the 5-year, >5-10 years, >10-15 years and >15-20 years accounted for 11%,12%,14% and 10% , respectively. 260 patients had grade 3 and 4 other injuries, including 55 skin, 79 muscles/soft tissue, 36 mucosa, 79 xerostomia and 11 trismus. Among 320 patients who suffered from caries of teeth, it involved all teeth in 192 patients. Two patients had mandible necrosis. 225 patients had decline of hearing. Among 672 ears in 336 patients,194 ears had severe deafness. The overall side reaction occurrence rate was 84.5%. Conclusions Different late side reactions do exist in nasopharyngeal carcinoma patients(84.5%) with long-term survival after radiotherapy, and some patients suffer side reactions so serious as to affect their quality of life. Cranial nerve injuries are not rare, and it may occur anytime after radiation, but it dose not stop as the patients survive along.