鼻咽癌新型施源器腔内后装治疗远期疗效分析

摘要

目的:分析鼻咽癌外照射联合新型施源器后装治疗的远期临床疗效及适应证.方法:将169例初治癌患者按治疗方法分为外照射联合腔内后装(综合治疗组)及单纯外照射(对照组)两组,综合治疗组中T1～T2期49例患者外照射剂量60～65Gy,T3～T4期24例外照射剂量70～75Gy,腔内后装在外照射后进行,剂量6～20Gy,中位剂量12Gy.对照组外照射剂量70～85Gy.结果:随访至2009年9月,随访率93.5%.T1～T2期患者综合治疗组和对照组近期有效率分别为93.9%、78.2%(P=0.023),T3～T4期患者分别为79.2%、65.9%(P=0.255).T1～T2期患者综合治疗组和对照组的5年生存率分别为85.0%、58.5%(P=0.006),5年局部控制率分别为91.4%、74.4%(P=0.031);T3～T4期患者分别为54.6%、47.4%(P=0.592),63.2%、58.1%(P=0.721).张口困难率综合治疗组与对照组分别为6.85%与18.8%(P=0.025).对照组出现严重治疗相关性并发症:鼻咽坏死4例,鼻咽大出血1例,脑坏死2例.复发后局部X刀治疗造成鼻咽大出血2例,脑坏死2例.而综合治疗组未出现严重并发症.结论:鼻咽癌外照射联合新型施源器后装治疗明显提高了T1～T2期患者5年生存率及局部控制率,T3～T4期患者未能体现出5年生存率与局控率的明显提高.后装治疗降低了鼻咽癌患者外照射剂量并减低了放疗并发症的发生,提高了生活质量.鼻咽癌颅底骨质及部分前组颅神经受侵的T3～T4期鼻咽癌患者也可应用后装治疗局部推量以降低放疗并发症的发生.%Objective: To evaluate the long-term efficacy of treatment with external-beam radiotherapy ( EBR ) plus intracavitary.branchytherapy (IBT) through using a new type of applicator for nasopharyngeal carcinoma ( NPC ) patients.Methods: A total of 169 NPC patients were recruited and dividcd into two groups.Patients in the comprchcnsive treatment group ( CTG ) were treatcd with EBR plus IBT Pafiants in the control group ( CG ) were treated by EBR alone.In CTG, the 49 patients with stage T1-T2 disease received a total dose of 60-65 Gy by EBR and the 24 patients ;vith stage T3-T4 disease received 70-75 Gy.The dose of brachytherapy ranged 6-20 Gy and the median dose was 12 Gy.In the CG, patients received a total dose of 70-80 Gy by EBR.Results: Till September 2009, 93.5％ patients were followed up.The short-term effective rate of thc treatment for T1-T2 patients was 93.9％ in CFG and 78.2％ in CG ( P= 0.023 ), and that for T3-T4 patients was 79.2％ in CTG and 65.9％ in CG ( P= 0.255 ).The 5-year overall survival rate (OSR ) and 5-year local control rate ( LCR ) of T1-T2 patietns were 85.0％ and 91.4％ in CTG, and 58.5％ and 74.4％ in CG ( P= 0.006,P= 0.031 ).The 5-year OSR and 5-year LCR of T3-T4 patients were 54.6％ and 63.2％ in CTG, and 47.4％ and 58.1％ in CG ( P=0.592, P= 0.721 ).The incidence of difficulty with opening mouth was 6.85％ in CTG and 18.8％ in CG ( P= 0.025 ).Patients in CG had serious treatment related complications, including postradiation nasopharyngeal necrosis in 4 cases, nasal hemorrhea in 2 cases,brain necrosis in 2 cases, nasal hcmorrhea in 2 cases, and brain necrosis in 2 recurrent cases.Two cases suffered from nasal hcmorrhea and another 2 cases had brain necrosis because of undergonging the second radiotherapy after nasal and skull base recurrence.No serous complications were observed in CTG.Conclusion: EBR plus IBT, through a new type of applicator, can improve the 5-year OSR and LCR in NPC patiants with stage T1-T2 disease, with a significant differcnce.IBT can lower the dose of EBR, reduce the radiation complications and improve patients' quality of life.NPC patients of stage T3-T4 with invasion in the bones of the skull base and formcr-group cranial nerves can be treated wtih IBT to increase local radiational dose and in order to decrease radiation complications.