NO期鼻咽癌放射治疗后的生存分析及失败模式

发布时间：2018-04-09 12:13

本文选题：鼻咽肿瘤　切入点：放射疗法　出处：《汕头大学》2011年硕士论文

【摘要】：背景与目的:鼻咽癌的生物学特点与颈部淋巴结转移的发生有关,所以N0期鼻咽癌在肿瘤生物学特点上与存在颈部淋巴结转移的鼻咽癌也可能有所不同。目前对N0期鼻咽癌的放疗疗效及治疗后的失败模式尚缺乏专门的探讨。本研究通过对N0期鼻咽癌患者临床资料的回顾性研究,分析患者的生存情况以及探讨其治疗失败模式,希望有助于进一步优化目前的治疗模式,改善患者的预后。方法:收集1989年5月至2009年10月610例N0期鼻咽癌患者的临床资料,所有患者治疗前均行颅底鼻咽部CT扫描。采用60Co治疗机γ线或直线加速器6MV-X线进行治疗,常规分割、连续放疗。多数病例采用面颈联合野照射DT 36～40 Gy后改用双耳前野加双上颈切线野照射。鼻咽原发病灶外照射剂量为34～91 Gy(中位剂量为70 Gy),颈部外照射剂量为34～70 Gy(中位剂量为50 Gy)。全组病例中共有68例患者接受双侧全颈或1侧全颈1侧上半颈预防照射,其余542例全部接受双侧上半颈预防照射。65例患者接受了放化疗综合治疗。外照射DT 70～72 Gy结束后共有99例患者存在鼻咽病灶残留,残留病灶加用腔内192Ir后装治疗或者小野适形外照射推量放疗。随访时间为3～254个月,中位随访时间为65.0个月。生存率分析采用Kaplan-Meier方法进行计算,Log-rank法检验差异显著性,Cox比例风险模型进行多因素分析。结果:5年和10年的生存结果:总生存率分别为78.7%和66.8%,无病生存率分别为68.8%和55.8%,疾病相关生存率分别为79.9%和70.4%,局部无失败生存率分别为81.2%和72.5%,区域无失败生存率分别为95.8%和91.8%,局部区域无失败生存率分别为78.3%和68.5%,无远处转移生存率分别为88.5%和85.5%。全组病例中颈部淋巴结复发31例(5.1%),以单纯颈部淋巴结复发为放疗后首发失败事件的15例(2.5%)。在全部有颈淋巴结复发的病人中,照射野内复发16例(2.6%),照射野外复发13例(2.1%),照射野内及野外复发2例(0.3%)。治疗后首次失败事件中,单纯局部失败100例,占所有失败患者的52.1%(100/192);单纯远处失败52例,占所有失败患者的27.1%(52/192)。多因素分析结果显示T分期是影响N0期鼻咽癌患者预后的独立因素(P = 0.000)。T分期(P = 0.000)、男性(P = 0.039)和贫血(P = 0.007)是影响无病生存率的独立不良预后因素。结论:N0期鼻咽癌患者有较好的预后,局部失败是治疗失败的主要原因,提高局部控制率将有助于延长患者的生存期。影响N0期鼻咽癌患者总生存率唯一的独立预后因素是T分期,影响无病生存率的独立不良预后因素是T分期、男性和贫血。
[Abstract]:Background & objective: the biological characteristics of nasopharyngeal carcinoma are related to the occurrence of cervical lymph node metastasis, so the biological characteristics of N0 nasopharyngeal carcinoma may be different from those of nasopharyngeal carcinoma with cervical lymph node metastasis.At present, there is a lack of specific discussion on radiotherapy efficacy and failure mode after treatment of N 0 nasopharyngeal carcinoma.In this study, the clinical data of N0 stage nasopharyngeal carcinoma patients were retrospectively studied, and the survival status and failure mode of N0 nasopharyngeal carcinoma patients were analyzed in order to further optimize the current treatment mode and improve the prognosis of the patients.Methods: the clinical data of 610 patients with stage N 0 nasopharyngeal carcinoma from May 1989 to October 2009 were collected.纬-ray of 60Co therapy machine or 6MV-X line of linear accelerator were used for treatment, routine fractionation and continuous radiotherapy.Most of the patients were irradiated with DT36 ~ 40 Gy in the face and neck combined field and then were irradiated with the anterior field of both ears and the tangent field of the double upper neck.The external dose of nasopharynx primary lesion was 3491 Gy (median dose was 70 Gy) and external dose of neck was 3470 Gy (median dose was 50 Gy).A total of 68 patients were treated with prophylactic irradiation on bilateral neck or 1 side of upper neck, and the remaining 542 cases were treated with combined radiotherapy and chemotherapeutic therapy in all. 65 cases were treated with prophylaxis and chemotherapeutic therapy.After the end of DT70 ~ 72Gy, there were 99 patients with residual nasopharynx lesions. The residual lesions were treated with intracavitary 192Ir afterloading or small-field conformal external irradiation and extrapolation radiotherapy.The follow-up time was 3 ~ 254 months and the median follow-up time was 65.0 months.Survival rate analysis Kaplan-Meier method was used to calculate Log-rank test difference significant Cox proportional risk model was used to carry out multivariate analysis.Results: the overall survival rate was 78.7% and 66.8%, the disease-free survival rate was 68.8% and 55.8%, the disease-related survival rate was 79.9% and 70.4%, the local failure free survival rate was 81.2% and 72.5%, the regional failure free survival rate was 81.2% and 72.5%, respectively.The local failure free survival rate was 78.3% and 68.5%, and the distant metastasis free survival rate was 88.5% and 85.5%, respectively.There were 31 cases of cervical lymph node recurrence in the whole group, and 15 cases with cervical lymph node recurrence as the first failure event after radiotherapy.Among all the patients with cervical lymph node recurrence, 16 cases had recurrence in the irradiation field, 13 cases had the recurrence in the field, 2 cases had the recurrence in the field and 2 cases had the recurrence in the field.In the first failure event after treatment, 100 cases were local failure, accounting for 52.1% / 100% of all failure patients, and 52 cases were simple distant failure, accounting for 27.1 / 52% of all failure patients.Multivariate analysis showed that T stage was an independent factor affecting the prognosis of N0 NPC patients (P = 0.0000.000, P = 0.000, P = 0.039) and anemia (P = 0.007) was an independent and adverse prognostic factor for disease-free survival.Conclusion the patients with stage N 0 nasopharyngeal carcinoma have good prognosis. Local failure is the main cause of failure in treatment. Increasing local control rate will help prolong the survival time of patients.T stage was the only independent prognostic factor affecting the overall survival rate of N0 NPC patients, and T stage, male and anemia were the independent adverse prognostic factors affecting the disease-free survival rate.
【学位授予单位】：汕头大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63

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