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目的 随机比较单纯常规外照射与外照射加近距离治疗对早期鼻咽癌原发灶的局部控制疗效和并发症。方法 对 12 6例初治的、福州分期为T1期和部分T2期 (口咽、颈动脉鞘、椎前软组织受侵者除外 )鼻咽癌病例进行前瞻性分组。单纯常规外照射组 (RT) 6 1例 ,外照射加192 Ir高剂量率近距离治疗组 (RB) 6 5例。 2 6例T1期在疗前经抽签随机接受单纯外照射 6 6～ 70Gy或外照射 5 6Gy加近距离治疗 10～ 16Gy,1～ 2次 (中位剂量 16Gy) ;10 0例T2期先采用常规外照射至 5 0Gy后 ,行CT或MRI检查 ,对咽旁间隙消退满意的病例入组随机接受单纯外照射 (中位剂量 72Gy)或外照射 (中位剂量 6 6Gy)加近距离治疗 8～ 2 4Gy ,1～ 3次 (中位剂量 16Gy)。近距离治疗在外照射结束后 1周进行 ,剂量参考点距施源器中心轴的距离为 7～ 12mm ,单次近距离照射剂量为 5～ 8Gy/周。结果 外照射结束时RT组鼻咽病灶残留 6例 ,消退 5 5例 ;RB组残留 13例 ,消退 4 6例 ,未评价 6例。RT组鼻咽部失败 8例 ,RB组鼻咽部失败 7例 (包括单独颅底失败 2例 )。 5年鼻咽 (颅底 )局部控制率RT组为 86 % ,RB组为 88%。 5年总生存率RT组为 83% ,RB组为 84 % (P =0 .84 )。放射性脑病RT组为 10例 ( 1级4例 ,2级 6例 ) ,RB组为 7例 ( 1级 4例 ,2级 3例 )。?
Objective To compare the local control efficacy and complications of primary conventional nasopharyngeal carcinoma with conventional external beam irradiation and brachytherapy. Methods A total of 126 cases of nasopharyngeal carcinoma were randomly divided into T1 group and partial T2 group (excluding oropharyngeal and carotid sheaths, except prevertebral soft tissue invaders) in Fuzhou. Sixty-one cases were treated with conventional external irradiation (RT) and 65 cases with 192 Ir high-dose brachytherapy (RB). Twenty-six T1 patients were randomized to receive a single extracorporeal irradiation of 6 6 ~ 70 Gy or external irradiation of 5 6 Gy plus 10 ~ 16 Gy, 1 ~ 2 times (median dose of 16 Gy) Conventional external beam irradiation to 50Gy, CT or MRI examination, satisfactory reduction of the parapharyngeal space of the patients enrolled were randomized to simple external beam irradiation (median dose 72Gy) or external irradiation (median dose 6 6Gy) plus close treatment 8 ~ 2 4Gy, 1 ~ 3 times (median dose of 16Gy). Brachytherapy was performed 1 week after the end of external irradiation. The distance between the reference point of dose and the center axis of the applicator was 7 ~ 12mm and the dose of single brachytherapy was 5 ~ 8 Gy / week. Results At the end of external irradiation, there were 6 cases of nasopharyngeal lesions left in RT group, which disappeared in 55 cases. There were 13 cases remaining in RB group, 46 cases subsided and 6 cases were not evaluated. 8 cases of nasopharyngeal failure in RT group, 7 cases of nasopharyngeal failure in RB group (including 2 cases of failure of skull base alone). In 5 years, the local control rate of nasopharyngeal (skull base) was 86% in RT group and 88% in RB group. The 5-year overall survival was 83% in the RT group and 84% in the RB group (P = .84). Radiation encephalopathy in RT group was 10 cases (grade 1 in 4 cases, grade 2 in 6 cases), RB group in 7 cases (grade 1 in 4 cases, grade 2 in 3 cases). ?