78例鼻咽癌调强放疗疗效和预后因素分析

发布时间：2018-06-04 19:33

本文选题：鼻咽肿瘤 + 调强放射疗法　；参考：《现代肿瘤医学》2016年12期

【摘要】：目的:评价鼻咽癌调强放疗的远期疗效、预后影响因素和不良反应。方法:回顾性分析近年来解放军第303医院采用IMRT初治的78例鼻咽癌患者。放疗处方剂量:鼻咽大体肿瘤靶区(GTVnx)74Gy/33次,颈部淋巴结大体肿瘤靶区(GTVnd)70Gy/33次,临床靶体积1(CTV1)62Gy/33次,临床靶体积2(CTV2)54Gy/33次。67例出现淋巴转移患者接受同步放化疗,同期化疗方案为顺铂(100mg/m~2第1、22、43天)。11例局部晚期患者接受了2个周期PF方案诱导化疗(顺铂30mg/m~2第1~3天+氟尿嘧啶900mg/m~2第1~4天)。结果:随访率为96.2%。全组患者3年OS、PFS、DMFS和LRFS分别为82.8%、77.6%、75.9%和81.0%。单因素分析显示影响无进展生存的因素有N分期(P=0.014)、同期放化疗是否加诱导化疗(P=0.00),影响无远处转移生存的因素有N分期(P=0.002)、同期放化疗是否加诱导化疗(P=0.00),年龄影响局部无复发生存(P=0.035)。多因素分析显示年龄是总生存、无进展生存、无远处转移生存和无局部复发生存的预后因素。急性不良反应主要为1和2级,全组患者3级晚期不良反应发生率仅有2.6%。结论:鼻咽癌IMRT技术提高了局部和区域控制率,降低了不良反应发生率,远处转移成为现阶段治疗失败主要模式。诱导化疗方式在局部晚期鼻咽癌治疗中的作用仍需进一步研究。
[Abstract]:Objective: to evaluate the long-term effect, prognostic factors and adverse reactions of intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods: 78 patients with nasopharyngeal carcinoma treated with IMRT in 303 Hospital of PLA in recent years were analyzed retrospectively. The dosage of radiotherapy prescription: GTV nxx 74 Gy / 33 times, cervical lymph node gross tumor 70 Gy / 33 times, clinical target volume 1(CTV1)62Gy/33 times, clinical target volume 2(CTV2)54Gy/33 times .67 cases with lymphatic metastasis received simultaneous radiotherapy and chemotherapy. At the same time, 11 patients with locally advanced chemotherapy received two cycles of PF regimen induction chemotherapy (cisplatin 30mg/m~2, day 1, day 1 and day 3, fluorouracil 900mg/m~2, day 14). Results: the follow-up rate was 96. 2%. For 3 years, the values of LRFS and LRFS in the whole group were 82.8% and 77.6%, 75.9% and 81.0%, respectively. Univariate analysis showed that the factors influencing progressive survival were: n stage P0. 014, P 0. 004, P 0. 002, P 0. 002, P 0. 002, age, P0. 03535. Multivariate analysis showed that age was the prognostic factor of total survival, no progressive survival, no distant metastasis and no local recurrence. Acute adverse reactions were mainly of grade 1 and 2, and the incidence of late adverse reactions of grade 3 in the whole group was only 2.6. Conclusion: IMRT technique can improve the local and regional control rate and decrease the incidence of adverse reactions. Distant metastasis is the main mode of failure. The role of induced chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma needs further study.
【作者单位】：桂林医学院研究生学院;中国人民解放军第303医院放疗科;
【分类号】：R739.63

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