| 江浩,汪庚明,宋宏伟,徐洪波,张亚军,周育夫,蔡汉飞,段诗苗.53例颈椎受侵鼻咽癌的常规和调强放疗疗效分析[J].中华放射医学与防护杂志,2014,34(3):211-214 |
| 53例颈椎受侵鼻咽癌的常规和调强放疗疗效分析 |
| Comparison of efficacy of intensity-modulated and conventional radiotherapy for nasopharyngeal carcinoma involving cervical vertebrae：analysis of 53 cases |
| 投稿时间：2013-07-09 |
| DOI：10.3760/cma.j.issn.0254-5098.2014.03.013 |
| 中文关键词: 鼻咽癌 颈椎侵犯 调强放疗 常规放疗 预后 |
| 英文关键词:Nasopharyngeal carcinoma Cervical vertebra involvement Intensity-modulated radiotherapy Conventional radiotherapy Prognosis |
| 基金项目:安徽省“十二五”临床医学重点专科建设基金（01Z33）；安徽省高校省级自然科学研究项目基金（KJ2007B199） |
|
| 摘要点击次数: 3038 |
| 全文下载次数: 2261 |
| 中文摘要: |
| 目的 比较颈椎受侵局部晚期鼻咽癌患者使用调强放疗（IMRT）和常规放疗的临床疗效及不良反应。方法 收集2006年1月至2012年12月颈椎受侵无远处转移的初治鼻咽癌患者53例，其中调强放疗24例，肿瘤靶区剂量72~74 Gy/33次。常规放疗29例，靶区剂量68~74 Gy /34~37次。全部患者接受顺铂+氟尿嘧啶方案的同步化疗及放疗后4~6周期的辅助化疗。结果 调强组和常规组3年总生存率为87.7%和65.5%，5年总生存率为45.5%和9.1%（χ2=6.89，P<0.05）；两组间的局部无进展3 年生存率分别为87.4%和69.9%，5年生存率为49.4%和9.4%（χ2=13.26，P<0.05）。但两组间的无远处转移3年生存率为94.4%和40.8%，5年生存率为 79.8%和30.4%，差异无统计学意义。N分期（χ2=8.53，P<0.05）和调强放疗（χ2=8.02，P<0.05）为患者总生存率及无进展生存率的相关因素。调强组放疗后口干的发生率显著低于常规组（Z=-2.67，P<0.05），两组患者急性口咽黏膜炎和骨髓不良反应的发生率差异无统计学意义。结论 与常规放疗相比，颈椎受侵局部晚期鼻咽癌患者行调强放疗能明显提高局部控制率和总生存率，但未能降低远处转移率；同时，调强放疗可以降低口干等不良反应发生率。 |
| 英文摘要: |
| Objective To compare the efficacy and side-effects of intensity-modulated radiotherapy (IMRT) and conventional radiotherapy in treatment of nasopharyngeal carcinoma (NPC) involving cervical vertebrae. Methods Twenty-four patients of NPC with cervical vertebra involvement underwent IMRT with the dose to tumor target of 72-74 Gy divided into 33 fractions (IMRT group), and 29 patients underwent conventional radiotherapy with the total dose to tumor target of 68-74 Gy/34-37 fractions (2D-CRT group). All the 53 cases accepted platinum-based concurrent chemotherapy of cisplatin plus fluorouracil and 4-6 cycles of adjuvant chemotherapy after the radiotherapy. Follow-up was conducted for 6 months to more than 7 years. Results The 3-and 5-year overall survival (OS) rates of the IMRT group were 87.7% and 65.5% respectively, both significantly higher than those of the 2D-CRT group (45.5% and 9.1% respectively, χ2=6.89, P<0.05), and the 3-and 5-year local progression-free survival (LPFS) rates of the IMRT group were 87.4% and 49.4% respectively, both significantly higher than those of the 2D-CRT group (69.9% and 9.4% respectively, χ2=13.26,P<0.05), and there were no significant statistical differences in the 3-, and 5-year distant metastasis-free survival (DMFS) rates (94.4% vs 40.8% and 79.8% vs 30.4% respectively, χ2=2.29,P>0.05) between two groups. Analysis showed N stage (χ2=8.53, P<0.05) and radiotherapy protocol (χ2=8.02, P<0.05) as the independent prognostic factors for OS and LPFS. The incidence of grade 2 and 3 xerostomia of the IMRT group was 29.17%, significantly lower than that of the 2D-CRT group (65.52%, χ2=7.11, P<0.05). Whereas, there were no significant statistical differences between these 2 groups in the incidence rates of acute irradiation mucositis and bone marrow suppression. Conclusions IMRT improves the local progression-free survival and overall survival and reduces the incidence of grade 2 and 3 radiation-induced xerostomia in local advanced NPC with cervical vertebra involvement more effectively than conventional radiotherapy. However, it fails to reduce the incidence of distant metastasis. |
| HTML 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|