局部复发老年鼻咽癌再程调强放射治疗的效果

摘要

Objective To investigate locally recurrent nasopharyngeal carcinoma in elderly patients and observe the long -term effects 0fintensitymodulatedradiationtherapy(IMRT).Methods 93casesofelderlypatientswithlocallyrecurrentnasopharyngealcarcinomawere selected from April 2011 to January 2015,re-course IMRT,1-,2-,3-year survival rates and causes of death were recorded ,and 3-year survival rateinpatientswithunivariateandmultivariateCOXregressionanalysis.Results 1-yearoverallsurvival,localrecurrence-freesurvival,dis-tant metastasis-free survival ,progression-free survival rates of local recurrence in elderly patients with nasopharyngeal carcinoma IMRT were 94.62 %,92.47%,90.32%,87.10%;2-year overall survival ,local recurrence-free survival ,distant metastasis-free survival ,progression-free survival rates were 90.32%,84.95%,84.95%,65.59%;3-year overall survival rate,local recurrence-free survival,distant metastasis-free survival,progression-free survival rates were 83.87%,47.31%,69.89%,77.42%.There were 47 cases of death in 93 patients with locally recurrent nasopharyngeal carcinoma then drove IMRT ,including 15 cases(31.91%)of locally advanced,10 cases(21.28%)of nasopharynge-al bleeding,9 cases(19.15%)of distant metastasis,4 cases(8.51%)of recurrence,other medical disorders 4 cases(8.51%),unexplained 5 cases(10.64%).Different ways of radiotherapy first drive ,rT stage,clinical stage,tumor size,recurrence interval,and then drove the radia-tion dose locally recurrent nasopharyngeal carcinoma in elderly patients and then drove IMRT had different 3 y-ear survival ( P<0.05 ) .rT stage,tumor size,and the process were independent risk factors for radiation dose locally recurrent nasopharyngeal carcinoma in elderly pa -tients and then drive IMRT 3-year survival rate ( P<0.05 ) affected.Conclusions The process then IMRT could significantly improve the sur-vival rate of local recurrence in elderly patients with nasopharyngeal carcinoma ,and its long-term effects are closely related with rT stage , tumor volume and re-irradiation dose .%目的：探讨局部复发老年鼻咽癌患者再程调强放疗的疗效。方法选取局部复发老年鼻咽癌患者93例，进行再程调强治疗，中位照射剂量是56．2 Gy（45～74．2Gy）；中位随访时间25．6个月（5～47个月）。记录患者1年、2年、3年生存率及死亡原因，并对患者3年生存率进行单因素和多因素COX回归分析。结果局部复发老年鼻咽癌患者再程调强放射治疗的1年总生存率、局部无复发生存率、无远处转移生存率、无进展生存率分别为94．62％、92．47％、90．32％、87．10％；2年总生存率、局部无复发生存率、无远处转移生存率、无进展生存率分别为90．32％、84．95％、84．95％、65．59％；3年总生存率、局部无复发生存率、无远处转移生存率、无进展生存率分别为83．87％、69．89％、77．42％、47．31％。93例局部复发老年鼻咽癌患者再程调强放射治疗后死亡47例（50．54％），其中局部进展15例（31．91％），鼻咽大出血10例（21．28％），远处转移9例（19．15％），再复发4例（8．51％），其他内科疾病4例（8．51％），原因不明5例（10．64％）。不同首程放疗方式、rT分期、临床分期、肿瘤体积、复发间隔时间、再程放疗剂量下局部复发老年鼻咽癌患者再程调强放射治疗的3年生存率差异显著（ P＜0．05）。 rT分期、肿瘤体积、再程放疗剂量是影响局部复发老年鼻咽癌患者再程调强放射治疗3年生存率的独立危险因素（ P＜0．05）。结论再程调强放射治疗能够明显提高局部复发老年鼻咽癌患者生存率，其长期效果与rT分期、肿瘤体积及再程放疗剂量密切相关。