鼻咽癌调强放疗与常规放疗的疗效及副反应对比研究

发布时间：2018-02-12 16:36

  本文关键词： 鼻咽癌 调强放疗 生存率 放疗副反应　出处：《广西医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的:对比研究调强放疗与常规放疗治疗鼻咽癌的有效率;1年、2年、3年总生存率、无进展生存率、局部区域控制率及放疗副反应,比较调强放疗与常规放疗的差异,调强放疗能否提高鼻咽癌患者有效率、提高生存率及降低副反应。 方法:随机收集2005年1月到2007年1月到我院就诊并接受治疗的60例调强放疗的初治鼻咽癌患者,排除远处转移,并以“鼻咽癌92分期”为标准,在同期二维常规放射治疗的患者中随机选取60例作为对照组,要求两组的年龄、性别及分期均无统计学差异。比较两组的疗效及放疗副反应。调强放疗组采用同步推量放疗方法给予靶体积处方剂量,GTVnx:T1、T2患者总量为69.9Gy,分30次,每次2.33Gy,T3、T4患者总量为73.9Gy,分32次,每次2.31Gy;GTVnd、CTV1、CTV2分别为66 Gy、60 Gy、54Gy,均30分次;阳性淋巴结复查有残留再加量至70Gy。常规放疗组采用两侧面颈联合大野加两侧面颈联合小野,下颈用切线照射加电子线,使用常规分割、常规剂量,2 Gy/次,5次/周。第一段采用面颈联合左右对穿野和下颈前切线野。照射DT36Gy;第二段避脊髓,照射DT 50Gy;第三段避脑干,照射DT66Gy;第四段照射至根治量,鼻咽部剂量70～76 Gy,阳性淋巴结剂量66Gy,复查有残留再加量至70Gy。两组中的Ⅲ期、Ⅳa期患者放疗期间同时行同步化疗,化疗方案参考NCCN指南:顺铂40mg/m~2,每周进行。 结果:(1)放疗结束时、放疗结束后3个月分别复查,调强放疗组CR率、治疗有效率均显著好于常规放疗组,差异有统计学意义(P0.05);(2)调强放疗组与常规放疗组相比,1年、2年、3年的总生存率、无进展生存率及局部区域控制率均无明显差异(P0.05);(3)调强组患者的急性皮肤反应、口干、张口受限等副反应明显低于常规组,差异有统计学意义(P0.05)。 结论:(1)与常规放疗相比,调强放疗能提高鼻咽癌患者的完全缓解率及有效率;(2)与常规放疗相比,调强放疗组并未提高1年、2年、3年总生存率、无进展生存率、局部区域控制率;(3)与常规放疗相比,调强放疗能降低急性皮肤反应、口干、张口受限等副反应的发生,提高患者生活质量。
[Abstract]:Objective: to compare the effective rate of intensity modulated radiotherapy (IMRT) with conventional radiotherapy, 1 year, 2 years, 3 years overall survival rate, progression free survival rate, local area control rate and side effects of radiotherapy, and compare the difference between intensity modulated radiotherapy and conventional radiotherapy. Intensity-modulated radiotherapy can improve the effective rate, increase the survival rate and reduce the side effects of nasopharyngeal carcinoma patients. Methods: from January 2005 to January 2007, 60 patients with nasopharyngeal carcinoma treated by intensity modulated radiotherapy were randomly collected, and distant metastasis was excluded. In the same period, 60 patients with conventional radiotherapy were randomly selected as the control group, asking for the age of the two groups. There was no statistical difference in sex and stage. The curative effect and the side effects of radiotherapy were compared between the two groups. The total dose of GTVnx: T1 / T2 in IMRT group was 69.9 Gy, 30 times, the total number of T3 T4 patients was 73.9 Gy, 32 times. The CTV2 of GTVndT CTV1 was 66 Gy / 60 Gy / 54.The positive lymph nodes had a residual dose of 70 Gy.The conventional radiotherapy group was treated with two sides of neck combined with large field plus two sides of neck combined with small field, and the lower neck was irradiated with tangent line plus electron line, and the routine segmentation was used. The patients in the conventional radiotherapy group were treated with two sides of neck combined with big field plus two sides of the neck combined with small field, and the lower neck was irradiated with tangent line plus electron line. The first segment was exposed to DT36Gy with the right and left of the faciocervical joint and the anterior tangent field of the lower neck. The second segment of the spinal cord was irradiated with DT50 Gy; the third segment of the brain stem was irradiated with DT66 Gy; and the fourth segment was irradiated to the radical dose. The nasopharynx dose was 70 ~ 76 Gy, the positive lymph node dose was 66 Gy, and the residual additional dose was 70 Gy. The patients in the two groups underwent concurrent chemotherapy during radiotherapy for stage 鈪，

本文编号：1506078