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目的:探索三维适形放疗(3demensionalconformalradiationtherapy3DCRT)技术在局部复发鼻咽癌再程放疗中的应用。方法:1998年4月～1999年10月,采用3DCRT技术治疗局部复发鼻咽癌26例。其中低分化鳞癌25例,低分化腺癌1例。按92’福州分期标准再分期:T1N0M04例,T2N0M08例,T3N0M09例,T4N0M05例。密集肿瘤区(grosstumorvolumeGTV)最大径1.0～5.0cm(平均3.1cm)。全组病例均采用每次5～7个固定适形野照射,计划靶区(planningtargetvolumePTV)平均最大剂量、最小剂量、平均剂量分别为104.1±1.3%、92.1±2.8%、99.2.±1.7%。时间-剂量-分次处方:65～70Gy/26～28次,共5～5.5周。随访8～26个月,中位随访时间17个月。结果:再程放疗后随访期内靶区边缘复发2例,颈淋巴结复发3例,远处转移2例,死亡4例。随访期内肿瘤局部控制率88.5%(23/26),84.6%(22/26)患者生存,76.9%(20/26)无瘤生存。再程放疗所致急性放射反应少而轻。累计后遗症发生率19.2%(5/26),放射性功能损害发生率15.4%4/26。结论:三维适形放疗技术用于局部复发鼻咽癌具有明显的剂量分布优势。初步临床观察结果表明,这一放疗新技术用于局部复发鼻咽癌肿瘤局部控制率高、放射反应和后遗症较少,远期疗效和后遗症尚有待观察。
Objective: To explore the application of three-dimensional conformal radiotherapy (3demensionalconformalradiationtherapy DCRT) in reradiation of locally recurrent nasopharyngeal carcinoma. Methods: From April 1998 to October 1999, 26 patients with locally recurrent nasopharyngeal carcinoma were treated with 3DCRT. Among them, 25 cases were poorly differentiated squamous cell carcinoma and 1 case was poorly differentiated adenocarcinoma. According to 92 ’Fuzhou staging staging: T1N0M04 cases, T2N0M08 cases, T3N0M09 cases, T4N0M05 cases. Dense tumor area (grosstumorvolumeGTV) maximum diameter 1.0 ~ 5.0cm (average 3.1cm). All the patients were treated with fixed conformal field irradiation of 5 ~ 7 times each. The average maximum dose, the minimum dose and the average dose of planning target volume were respectively 104.1 ± 1.3% and .192.1 ± 2.8% 99.2. ± 1.7 %. Time - Dose - Graded prescription: 65 ~ 70Gy / 26 ~ 28 times, a total of 5 ~ 5.5 weeks. Follow up for 8 to 26 months, the median follow-up time of 17 months. Results: In the follow-up period after reradiation, there were 2 cases of recurrence at the margin, 3 cases of cervical lymph node recurrence, 2 cases of distant metastasis and 4 cases of death. The tumor local control rate was 88.5% (23/26) during the follow-up period, 84.6% (22/26) patients survived, and 76.9% (20/26) had no disease-free survival. Radiotherapy due to acute radiation response is less and less. The cumulative incidence of sequelae 19.2% (5/26), the incidence of radioactive injury 15.4% 4/26 . Conclusion: Three-dimensional conformal radiotherapy has the advantage of dose distribution for local recurrence of nasopharyngeal carcinoma. Preliminary clinical observations show that the new radiotherapy technology for local recurrence of nasopharyngeal carcinoma with high local control rate, fewer radiological reactions and sequelae, long-term efficacy and sequelae remains to be seen.