140例局部复发鼻咽癌患者三维适形放疗的疗效分析

摘要

Background and purpose: Local recurrences of nasopharyngeal carcinoma (NPC) may be salvaged by re-irradiation using conventional techniques, but with significant morbidity. Three-dimensional conformal radiation therapy (3D-CRT) may improve the therapeutic ratio by reducing doses to normal tissue. The aim of this study was to address the efficacy and toxicity profile of 3D-CRT for 140 patients with locally recurrent NPC. Methods: From May 1997 to Jun. 2009,140 patients diagnosed with locally recurrent NPC by biopsy and/or CT/MRI evidence of progressive skull base erosion and clinical symptoms were treated with 3D-CRT. Median time to recurrence was 27.5 months (ranged from 1 to 156 months) after the completion of conventional radiation to definitive dose. 50.7% of the cases had rTM classification. Minimum planned doses of 3D-CRT treatment were 59.4-60 Gy in 1.8-2 Gy per daily fraction to the gross disease with margins, with or without chemotherapy. Results: The median dose to the recurrent tumor of reirradiation was 62 Gy (ranged from 50 to 77.4 Gy). With a median follow-up of 25.5 months (ranged from 3 to 135 months), the overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRRFS) rates at 3- and 5-year were 44.53% vs 31%, 42.82 vs 29.13%, 44.19% vs 30.76%, respectively. Moderate to severe late toxicities were noted in 48 patients (34.3%). Thirteen patients (9.29%) had posterior nasal space ulceration, 21 (15%) developed to cranial nerve palsies, 20 (14.3%) had trismus, and 16(11.4%) suffered deafness. Older age was an adverse prognostic factor. Conclusion: Re-irradiation with 3D-CRT provides reasonable long-term control in patients with locally recurrent NPC with acceptable profile of adverse-effects. The overall survival at 3- and 5-year were 44.53% vs 31%.%背景与目的:局部复发鼻咽癌再次放疗的方式很多,但常规放疗后良反应大,目前关于三维适形放疗(three dimensional conformal radiation therapy,3D-CRT)治疗复发鼻咽癌的报道较少,本研究旨在分析3D-CRT对140例局部复发鼻咽癌患者的疗效及其不良反应.方法:本院于1997年5月-2009年6月对140例经病理活检和(或)通过CT/MRI证实颅底病变或颅神经症状进展而确诊为局部复发的鼻咽癌患者采用3D-CRT治疗.患者中位复发时间为27.5个月(1～156个月),50.7％患者的复发为T3-4期,患者3D-CRT治疗的最小计划放疗剂量是GTV-P为DT 59.4 Gy/1.8～2 Gy(联合或不联合化疗).结果:复发后中位照射剂量是62 Gy (39～82 Gy)；中位随访时间25.5个月(3～135个月),随访率100％.3、5年的总生存率(overall survival,OS),无瘤生存率(disease-free survival,DFS),局部控制率(locoregional recurrence-free survival,LRRFS)分别为44.53％ vs 31％,42.82％ vs 29.13％,44.19％ vs 30.76％.48例患者(34.3％)出现中重度并发症,其中鼻咽溃疡13例(9.29％),颅神经损伤21例(15％),张口困难20例(14.3％),听力下降16例(11.4％).多因素分析显示年龄是独立的预后不良因素.结论:采用3D-CRT对局部复发鼻咽癌安全、有效,不良反应可以耐受.