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49例鼻咽癌调强放疗后复发的临床分析

发布时间:2018-07-01 16:17

  本文选题:鼻咽癌 + 调强适形放疗 ; 参考:《广西医科大学》2015年硕士论文


【摘要】:目的 通过回顾性分析鼻咽癌调强放疗后复发患者的临床资料,初步探讨鼻咽癌调强放疗后复发的临床特征与规律,为进一步提高鼻咽癌的调强放疗疗效提供依据,进而提高局部控制率、生存率。资料与方法收集2009年1月至2014年12月在广西医科大学第一附属医院放疗科调强放疗后复发的49例鼻咽癌患者的临床资料,对复发时间、部位、分期、靶区及剂量等因素进行分析。等级资料采用秩和检验,通过SPSS16.0统计软件进行统计分析,P0.05为差异有统计学意义。结果1.复发中位时间为20个月,放疗后6-12个月复发的病例占8.2%,12~18个月复发的占34.7%,18~24个月复发的占22.4%,24~30个月复发的占26.5%,30-36个月复发的占2.0%,放疗后3年内累计复发的病例占93.9%,3年复发的病例仅有6.1%。2.单纯局部复发为57.1%(28/49),单纯区域复发为22.4%(11/49),局部+区域复发为20.4%(10/49)。局部复发受侵概率较高的部位有:岩尖(60.5%)、斜坡(57.9%)、蝶骨基底部(55.2%)、翼腭窝(47.3%)、翼突(44.7%)。区域复发21例(42.8%)分布,Ⅱ区57.1%,Ⅲ区23.8%,Ⅳ区9.5%,锁骨下区4.8%,腮腺后缘下区4.8%。3.49例复发患者按2009’UICC/AJCC分期后为:Ⅰ期4.1%(2/49),Ⅱ期24.5%(12/49),Ⅲ期26.5%(13/49),Ⅳa期40.8%(20/49),Ⅳb期4.1%(2/49),根据2009’UICC/AJCC分期系统回顾鼻咽癌分期(原分期):Ⅱ期6.1%(3/49),m期40.8%(20/49),Ⅳa期51.0%(25/49),Ⅳb期2.0%(1/49)。通过Wilcoxon秩和检验对原分期和复发分期比较:12.2%(6/49)患者复发的T分期比原T分期更晚期,然而,51.0%(25/49)原T分期比复发T分期更晚期(P=-0.029);有57.1%(28/49)复发患者N分期比原N分期更早期,然而,8.2%(4/49)的原N分期比复发N分期更加早期(P=-0.001),有34.7%患者复发是N分期与原N分期相同。对于总TNM分期,16.3%(8/49)患者复发临床分期比原临床分期更加晚期,然而,38.8%(19/49)原临床分期比复发临床分期更加晚期(P0.005)。4.野内复发的47例患者(单纯局部复发28例,局部+区域复发10例,区域复发9例);野外复发2例(左腮腺后缘复发1例,左锁骨下区淋巴结复发1例)。结论1.鼻咽癌调强放疗后复发的中位时间为20个月,且大部分在3年内。2.鼻咽癌调强放疗后的复发部位,鼻咽部以颅底多见,颈部以Ⅱ区为主。3.调强放疗后的复发大部分为野内复发。
[Abstract]:Objective through retrospective analysis of the clinical data of recurrent nasopharyngeal carcinoma after intensity modulated radiotherapy, the clinical characteristics and regularity of recurrent nasopharyngeal carcinoma after intensity modulated radiotherapy were preliminarily discussed in order to provide a basis for further improving the effect of intensity modulated radiotherapy for nasopharyngeal carcinoma, and then to improve the local control rate and survival rate. Data and methods were collected from January 2009 to December 2014. The clinical data of 49 cases of nasopharyngeal carcinoma relapsed after intensity modulated radiotherapy in the First Affiliated Hospital of West Medical University were analyzed. The recurrence time, location, stage, target area and dose were analyzed. Rank sum test was used and statistical analysis was carried out by SPSS16.0 statistical software. The difference of P0.05 was statistically significant. Results 1. relapse. The time was 20 months, the recurrence of 6-12 months after radiotherapy accounted for 8.2%, 12~18 months recrudescence 34.7%, 18~24 months recrudescence 22.4%, 24~30 months recrudescence 26.5%, 30-36 months relapse 2%, recurrent cases within 3 years after radiotherapy accounted 93.9%, only 6.1%.2. local recurrence (28/49), only recurrent cases relapsed years, simple Regional recurrence was 22.4% (11/49) and local recurrence was 20.4% (10/49). Local recurrence was higher in the region of rock tip (60.5%), slope (57.9%), basal part of sphenoid bone (55.2%), pterygopalatine fossa (47.3%), pterygopalatine (44.7%). Regional recurrence 21 cases (42.8%), 57.1%, III region 23.8%, IV region 9.5%, subclavian 4.8%, 4.8%.3.4 in the lower parotid region. 9 cases of recurrent patients were followed by 2009 'UICC/AJCC stages: stage I 4.1% (2/49), stage II 24.5% (12/49), stage III 26.5% (13/49), stage IV A 40.8% (20/49), stage IV B 4.1% (2/49), according to 2009' UICC/AJCC stage system review of nasopharyngeal carcinoma staging (stage 6.1% (3/49), M phase 40.8% (20/49), IV 51%, IV 2% period 2%). The rank sum test compared the original staging and recurrence staging: 12.2% (6/49) patients had more advanced T stages than original T staging, however, 51% (25/49) T staging was more advanced than that of recurrent T staging (P=-0.029), and 57.1% (28/49) recurred patients were more early than original N staging, but 8.2% (4/49) primary N staging was earlier than recurrent staging. The recurrence of 34.7% patients was the same as the N staging and the original N staging. For the total TNM staging, the recurrent clinical stages of the 16.3% (8/49) patients were more advanced than the original clinical staging. However, the 38.8% (19/49) primary clinical staging was more advanced than the recurrent clinical staging (P0.005) in the.4. intratumoral recurrence (28 cases of local recurrence, 10 local recurrent cases, regional relapse, and regional relapse. In 9 cases, there were 2 cases of field recurrence (1 cases of left parotid posterior margin recurrence and 1 cases of left subclavian lymph node recurrence). Conclusion the median time of recurrence of 1. nasopharyngeal carcinoma after intensity modulated radiotherapy is 20 months, and most of the recurrent sites of.2. nasopharyngeal carcinoma after intensity modulated radiotherapy in 3 years, the nasopharynx is more common in the skull base, and the recurrence of the neck is mainly after the.3. intensity modulated radiotherapy in the second region of the neck region. It is divided into a recurrence in the field.
【学位授予单位】:广西医科大学
【学位级别】:硕士
【学位授予年份】:2015
【分类号】:R739.63

【参考文献】

相关期刊论文 前10条

1 钟碧玲,宗永生;鼻咽癌中p53蛋白积聚对瘤细胞有丝分裂和凋亡的影响[J];癌症;2000年05期

2 黄慧强,周中梅,李宇红,姜文奇,何友兼,滕小玉,管忠震;异环磷酰胺加阿霉素治疗放化疗后复发转移鼻咽癌的初步结果[J];癌症;2002年04期

3 卢泰祥;局部复发鼻咽癌诊治研究进展[J];癌症;2004年02期

4 刘丽东;苏丹柯;金观桥;赵梦欧;李强;黄伟丽;;多层螺旋CT灌注成像对鼻咽癌复发的诊断价值研究[J];当代医学;2009年20期

5 林少俊;陈传本;韩露;郑葳;陈梅;潘建基;;鼻咽癌调强放射治疗230例初步结果[J];福建医科大学学报;2007年01期

6 朱军;缪青;谭旭艳;梅泽如;;超声学检查对鼻咽癌颈淋巴结肿大的诊疗价值[J];临床肿瘤学杂志;2007年12期

7 林映如,陈应瑞,李伟雄;FDG-PET判断鼻咽癌放疗后复发的临床价值[J];实用医学杂志;2005年20期

8 袁健;孙宁;王丽京;田伟;周小明;陈东波;;鼻咽癌放射敏感性异质性的形态学差异观察[J];实用肿瘤杂志;2007年04期

9 褚汉启;熊浩;Jamal Alhosam;周良强;张平;黄孝文;崔永华;;鼻咽癌组织LMP-1表达与外周血EBV-IgA/VCA的关系[J];华中科技大学学报(医学版);2008年04期

10 夏俊阳,张文中,刘锋,徐灵靖;三种不同鼻咽部活检方法对鼻咽癌的诊断价值[J];江苏临床医学杂志;2000年04期



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