鼻咽癌残存病灶分次立体定向放射治疗临床研究
发布时间：2018-08-14 11:39
【摘要】：第一部分分次立体定向放疗在残存鼻咽癌治疗中的作用 目的：总结我院应用分次立体定向放疗(FSRT)推量治疗鼻咽癌根治性外照射后残存病灶的结果,进一步探讨分次立体定向放疗在局部残存鼻咽癌治疗中的作用。 资料和方法：回顾性分析我院放疗科2000年1月至2009年12月收治的136例首程根治性放疗后局部残存鼻咽癌患者资料。男性104例(76.5%),女性32(23.5%)例；中位年龄43.0岁(13-77岁)；初诊分期(2002年UICC)为：Ⅰ期1例(0.8%),Ⅱ a期6例(4.4%),Ⅱ b期24例(17.6%),Ⅲ期70例(51.5%),Ⅳa期24例(17.6%),Ⅳb期11例(8.1%)。首程放疗鼻咽部总剂量为68.0-78.0Gy(中位剂量70.0Gy),其中常规放疗85例,调强放疗51例。首程放疗与FSRT的中位时间为24.5天。残存病灶体积为0.60-77.13cm3(中位体积13.45cm3)。FSRT总剂量为8.0-32.0Gy(中位剂量19.5Gy),单次剂量2.0-10.0Gy/次(33例5Gy,103例≤5Gy)。FSRT的BED为10.1-44.8Gy(中位数为28Gy)。应用Kaplan-Meier和Cox回归分析研究各因素对预后的影响。 结果：完全缓解率为72.1%,部分缓解率为23.5%。全组病人的5年无局部失败生存率(LFFS)、5年无远转生存(FFDM)率、5年总生存率(OS)和5年无病生存率(DFS)分别为92.5%,77.0%,76.2%和73.6%。36例(26.8%)在FSRT后出现远处转移(中位时间9个月)。Ⅰ+Ⅱ期和Ⅲ+Ⅳ期患者的5年LFFS分别为89.9%和93.3%,DFS分别为83.2%和70.8%,OS分别为86.3%和70.7%；均无统计学差异。19例出现晚期并发症(8例颅神经损伤,5例鼻咽部大出血,6例颞叶坏死)。多因素分析显示T分期是DFS和OS的独立预后因素,年龄是OS的另一预后因素。 结论：分次立体定向放射治疗对鼻咽癌放疗后残存病灶的推量治疗有显著临床疗效,严重晚期并发症的发生率可接受。改进的剂量分割模式可减少晚期并发症的发生。 第二部分保护颈动脉鞘的鼻咽癌立体定向推量放疗初探 目的：本研究采用保护颈鞘技术的分次立体定向放疗推量治疗鼻咽癌根治性外照射后残存病灶,评价其疗效及其并发症。 材料与方法：2006年8月至2010年8月,36例我院鼻咽癌初程根治性放疗后局部残存患者接受分次立体定向放射治疗(FSRT)推量。患者中位年龄41.3岁(13-76岁),男性25例,女性11例。初诊UICC2002分期为Ⅱa期2例,Ⅱ b期5例,Ⅲ期18例,Ⅳa期7例,Ⅳb期4例。残存肿瘤部位为：限于鼻咽腔(52.8%),鼻咽腔并咽旁间隙(8.3%),咽后淋巴结(19.4%),鼻咽腔并咽后淋巴结(13.9%),咽旁间隙并咽后淋巴结(2.8%),海绵窦(2.8%)。首程放疗鼻咽部总剂量69.96-76.90Gy(中位剂量72.58Gy),其中常规放疗9例,调强放疗27例,首程同步放化疗20例。首程放疗与FSRT的间隔时间为12-147天(中位时间39.8天)。残存肿瘤体积为1.46cm3-32.98cm3(中位体积14.94mm3)。FSRT应用小多叶光栅旋转适形照射,颈动脉鞘受量低于2Gy/次。FSRT总剂量10.0-24.0Gy(中位剂量16.5Gy),2.0-5.0Gy/次,常用分割方式为15Gy/3Gy/5f。 结果：随诊时间为12-59月(中位时间为34月),肿瘤完全缓解率为100%。3年局部控制率为100%；3年总生存率为94.4%；3年无病生存率为77.8%。无严重急性放疗反应发生,晚期并发症包括1例(2.8%)轻度后组颅神经损伤,2例(5.6%)颞叶坏死：无鼻咽部大出血或溃疡发生。 结论：本组立体定向放射治疗剂量分割模式对首程放疗后残存鼻咽癌有显著临床疗效,FSRT注重保护颈鞘有利于降低放疗后晚期神经、血管损伤。
[Abstract]:Part I the role of fractionated stereotactic radiotherapy in the treatment of residual nasopharyngeal carcinoma
Objective: To summarize the results of fractionated stereotactic radiotherapy (FSRT) in the treatment of residual nasopharyngeal carcinoma (NPC) after radical external irradiation.
Materials and Methods: A retrospective analysis of 136 patients with locally residual nasopharyngeal carcinoma (NPC) after first-course radical radiotherapy from January 2000 to December 2009 was carried out. 104 males (76.5%) and 32 females (23.5%) were involved; the median age was 43.0 years (13-77 years); the initial stage (2002 UICC) was stage I (0.8%), stage II a (4.4%) and stage II B (24.4%). The total dose of nasopharyngeal radiotherapy was 68.0-78.0 Gy (median dose 70.0 Gy), including 85 cases of conventional radiotherapy and 51 cases of intensity modulated radiotherapy. The BED of FSRT was 10.1-44.8 Gy (median 28 Gy). Kaplan-Meier and Cox regression were used to analyze the prognostic factors.
Results: Complete remission rate was 72.1% and partial remission rate was 23.5%. The 5-year LFFS, 5-year FFDM, 5-year OS and 5-year DFS were 92.5%, 77.0%, 76.2% and 73.6% respectively. 36 patients (26.8%) had distant metastasis after FSRT (median time was 9 months). LFFS were 89.9% and 93.3% in stage IV patients, 83.2% and 70.8% in DFS, 86.3% and 70.7% in OS, respectively. There was no significant difference between the two groups. Prime.
CONCLUSION: The fractionated stereotactic radiotherapy is effective in the treatment of residual nasopharyngeal carcinoma after radiotherapy, and the incidence of severe late complications is acceptable.
The second part of the study of stereotactic radiotherapy for nasopharyngeal carcinoma with carotid sheath protection
Objective: To evaluate the efficacy and complications of fractionated stereotactic radiotherapy with cervical sheath protection in the treatment of residual nasopharyngeal carcinoma after radical external irradiation.
Materials and Methods: From August 2006 to August 2010, 36 patients with locally residual nasopharyngeal carcinoma received fractionated stereotactic radiotherapy (FSRT). The median age was 41.3 years (13-76 years), 25 males and 11 females. The remaining tumor sites were limited to nasopharyngeal cavity (52.8%), parapharyngeal space (8.3%), retropharyngeal lymph node (19.4%), parapharyngeal space (13.9%), retropharyngeal lymph node (2.8%) and cavernous sinus (2.8%). The total dose of nasopharyngeal radiotherapy was 69.96-76.90 Gy (median dose 72.58 Gy), including 9 cases of conventional radiotherapy, 27 cases of intensity modulated radiotherapy, and 27 cases of primary radiotherapy. The interval between first-course radiotherapy and FSRT was 12-147 days (median time 39.8 days). The residual tumor volume was 1.46 cm 3-32.98 cm 3 (median volume 14.94 mm 3). FSRT was irradiated with multilobular Grating Rotational conformal radiation. The total dose of FSRT was 10.0-24.0 Gy (median dose 16.5 Gy) and 2.0-5.0 Gy (median dose 16.5 Gy) respectively. The way is 15Gy/3Gy/5f..
Results: The follow-up time was 12-59 months (median time was 34 months). The complete remission rate was 100%. The 3-year local control rate was 100%. The 3-year overall survival rate was 94.4%. The 3-year disease-free survival rate was 77.8%. There was no severe acute radiation reaction. The late complications included 1 case (2.8%) of mild cranial nerve injury in the posterior group, 2 cases (5.6%) of temporal lobe necrosis: no nasopharynx. Massive bleeding or ulceration.
Conclusion: The dose-splitting mode of stereotactic radiotherapy has a significant clinical effect on the residual nasopharyngeal carcinoma after the first-course radiotherapy. FSRT can reduce the nerve and blood vessel injury in the late stage of radiotherapy.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R739.63
本文编号：2182742
[Abstract]:Part I the role of fractionated stereotactic radiotherapy in the treatment of residual nasopharyngeal carcinoma
Objective: To summarize the results of fractionated stereotactic radiotherapy (FSRT) in the treatment of residual nasopharyngeal carcinoma (NPC) after radical external irradiation.
Materials and Methods: A retrospective analysis of 136 patients with locally residual nasopharyngeal carcinoma (NPC) after first-course radical radiotherapy from January 2000 to December 2009 was carried out. 104 males (76.5%) and 32 females (23.5%) were involved; the median age was 43.0 years (13-77 years); the initial stage (2002 UICC) was stage I (0.8%), stage II a (4.4%) and stage II B (24.4%). The total dose of nasopharyngeal radiotherapy was 68.0-78.0 Gy (median dose 70.0 Gy), including 85 cases of conventional radiotherapy and 51 cases of intensity modulated radiotherapy. The BED of FSRT was 10.1-44.8 Gy (median 28 Gy). Kaplan-Meier and Cox regression were used to analyze the prognostic factors.
Results: Complete remission rate was 72.1% and partial remission rate was 23.5%. The 5-year LFFS, 5-year FFDM, 5-year OS and 5-year DFS were 92.5%, 77.0%, 76.2% and 73.6% respectively. 36 patients (26.8%) had distant metastasis after FSRT (median time was 9 months). LFFS were 89.9% and 93.3% in stage IV patients, 83.2% and 70.8% in DFS, 86.3% and 70.7% in OS, respectively. There was no significant difference between the two groups. Prime.
CONCLUSION: The fractionated stereotactic radiotherapy is effective in the treatment of residual nasopharyngeal carcinoma after radiotherapy, and the incidence of severe late complications is acceptable.
The second part of the study of stereotactic radiotherapy for nasopharyngeal carcinoma with carotid sheath protection
Objective: To evaluate the efficacy and complications of fractionated stereotactic radiotherapy with cervical sheath protection in the treatment of residual nasopharyngeal carcinoma after radical external irradiation.
Materials and Methods: From August 2006 to August 2010, 36 patients with locally residual nasopharyngeal carcinoma received fractionated stereotactic radiotherapy (FSRT). The median age was 41.3 years (13-76 years), 25 males and 11 females. The remaining tumor sites were limited to nasopharyngeal cavity (52.8%), parapharyngeal space (8.3%), retropharyngeal lymph node (19.4%), parapharyngeal space (13.9%), retropharyngeal lymph node (2.8%) and cavernous sinus (2.8%). The total dose of nasopharyngeal radiotherapy was 69.96-76.90 Gy (median dose 72.58 Gy), including 9 cases of conventional radiotherapy, 27 cases of intensity modulated radiotherapy, and 27 cases of primary radiotherapy. The interval between first-course radiotherapy and FSRT was 12-147 days (median time 39.8 days). The residual tumor volume was 1.46 cm 3-32.98 cm 3 (median volume 14.94 mm 3). FSRT was irradiated with multilobular Grating Rotational conformal radiation. The total dose of FSRT was 10.0-24.0 Gy (median dose 16.5 Gy) and 2.0-5.0 Gy (median dose 16.5 Gy) respectively. The way is 15Gy/3Gy/5f..
Results: The follow-up time was 12-59 months (median time was 34 months). The complete remission rate was 100%. The 3-year local control rate was 100%. The 3-year overall survival rate was 94.4%. The 3-year disease-free survival rate was 77.8%. There was no severe acute radiation reaction. The late complications included 1 case (2.8%) of mild cranial nerve injury in the posterior group, 2 cases (5.6%) of temporal lobe necrosis: no nasopharynx. Massive bleeding or ulceration.
Conclusion: The dose-splitting mode of stereotactic radiotherapy has a significant clinical effect on the residual nasopharyngeal carcinoma after the first-course radiotherapy. FSRT can reduce the nerve and blood vessel injury in the late stage of radiotherapy.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R739.63
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