鼻咽癌调强放射治疗51例临床疗效分析

摘要

目的 观察鼻咽癌调强放射治疗的急性毒副反应和近期疗效,并于三维适形放射治疗比较.方法 2008年5月-2009年5月对51例鼻咽癌患者采用调强放射治疗(IMRT): 1次/日,5次/周,GTV分次剂量为2.2Gy,其处方剂量为70.4～74.8Gy/32～34次;CTV1分次剂量为1.8 Gy,处方剂量为61.2～64.8 Gy/34～36次;CTV2分次剂量为2 Gy,处方剂量为50～54 Gy/25～27次;对59例鼻咽癌患者采用三维适形放射治疗(3D-CRT):分次剂量为2 Gy,1次/日,5次/周.GTVnx处方剂量70～78 Gy/35～39次,GTVnd处方剂量70 Gy/35次,CTV1处方剂量60～64Gy/30～32次,CTV2处方剂量50～54Gy/25～27次,有残留者适当缩野补量.采刚放化综合治疗,结合患者分期情况给予顺铂+氟腺嘧啶方案化疗,中位随访时间17个月.结果 DVH分析显示IMRT可以获得较好的靶区剂量分布,正常组织保护好,特别是对腮腺的保护.RTOG标准评价急性反应均可耐受,IMRT组未发生严重的4级不良反应,IMRT组患者口干程度明显较3D-CRT组减轻.近期疗效:CR28例,PR3例,总有效率(CR+PR)100%.1年总生存率为100%.结论 IMRT在剂量分布和可耐受的毒性反应方面优于3D-CRT,近期临床疗效令人满意,但远期疗效和后期并发症还需进一步观察,且最佳的治疗模式有待于进一步研究.%Objective To observe the acute toxicity and preliminary clinical efficacy of intensify modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).And compare it with threedimensional conformal radiotherapy ( 3D-CRT ). Methods From May 2008 to May 2009, 51patients with nasopharyngeal carcinoma were treated by IMRT with 2.2Gy/fraction at gross tumor volume (GTV) to a total dose of 70.4-74.8Gy/32-34 fraction, 1.8Gy/fraction at the clinical treatment volume Ⅰ (CTV 1) to a total dose of 61.2-64.8Gy/34-36 fraction and 2.0Gy/fraction at the clinical treatment volume Ⅱ (CTV2) to a total dose of 50-54Gy/25-27 fraction: 59 patients with nasopharyngeal carcinoma were treated by 3D-CRT with 2.0Gy/fraction at gross tumor volume-nx (GTVnx) to a total dose of 70-78 Gy/35-39 fraction,2.0Gy/fraction at gross tumor volume-nd (GTVnd) to a total dose of 70Gy/35 fraction, 2.0Gy/fraction at the clinical treatment volume Ⅰ (CTV 1) to a total dose of 60-64Gy/30-32 fraction and 2.0Gy/fraction at the clinical treatment volume Ⅱ (CTV2) to a total dose of 50-54Gy/25-27 fraction. Using chemotherapy of DDP+5-Fu in depend on the stage, Results Dose volume histogram ( DVH ) showed a better dose distribution and protection for normal tissue in group of IMRT, especially parotid.Acute toxicity was well tolerated and no grade V side effects occurred in group of IMRT. The patients showed xerostomia by IMRT are less than the group by 3D-CRT. The difference between the two groups was obvious. 28 patients had complete response(90.3%) while 3 patients had partial response after completion of treatment, giving a 1-year survival rate of 100%. Conclusion IMRT yields better dose distribution and acceptable toxicity than the 3D-CRT in both early and advanced stage nasopharyngeal carcinoma. The preliminary clinical result is encouraging, but clinical efficacy and complications for long-term need to be further studied.