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目的探讨三维适形放疗治疗加常规放射治疗鼻咽癌的疗效与优势。方法初次治疗78例鼻咽癌患者,分两阶段对原发灶及颈部放射治疗。第一阶段针对鼻咽部病灶以及颈部转移病灶采用三维适形放射治疗,单次剂量2～5Gy,每周5次,总剂量30Gy。第二阶段T1N0或部分T2N0鼻咽癌患者行两耳前野DT55Gy+前后颈切野照射DT50Gy,颈部中间加一个3cm挡块。颈淋巴结转移患者行面颈联合两侧野照射DT55Gy(40Gy后缩野避开脊髓和脑干)+中下颈前后切野DT55Gy,均为常规分割放疗,射野上界保持与主野下界衔接。结果治疗结束后3个月局部肿瘤(原发灶和颈部淋巴结)完全缓解率、部分缓解率、无变化率以及进展率分别为38.5%、55.1%、5.1%、1.3%,总有效率(CR+PR)为93.6%。肿瘤1、2、3、5年局控率分别为92.3%、88.5%、78.2%、70.5%。1、2、3、5年生存率分别为96.2%、89.7%、83.3%、71.8%。出现的早期放射反应都能耐受,在随访过程中未观察到明显的张口困难或后组颅神经损伤。结论鼻咽癌三维适形放射治疗加常规放射治疗的近远期疗效肯定。
Objective To investigate the efficacy and advantages of three-dimensional conformal radiotherapy and conventional radiotherapy of nasopharyngeal carcinoma. Methods The initial treatment of 78 cases of nasopharyngeal carcinoma patients in two stages on the primary tumor and neck radiotherapy. The first phase of nasopharyngeal lesions and neck metastases using three-dimensional conformal radiotherapy, a single dose of 2 ~ 5Gy, 5 times a week, the total dose of 30Gy. The second stage T1N0 or partial T2N0 nasopharyngeal carcinoma patients before and after DT52Gy + anterior cervical field irradiation DT50Gy, neck plus a 3cm stopper. Patients with cervical lymph node metastases were treated with DT55Gy (40Gy transcontinental avoidance of the spinal cord and brainstem) and DT55Gy incision in both anterior and posterior cervical spine. All patients were routinely divided radiotherapy. Results The complete remission rate, partial remission rate, no change rate and progress rate of local tumor (primary tumor and cervical lymph node) were 38.5%, 55.1%, 5.1% and 1.3% respectively at 3 months after the end of treatment. The total effective rate CR + PR) was 93.6%. The local control rates of tumors at 1, 2, 3 and 5 years were 92.3%, 88.5%, 78.2% and 70.5% respectively. The 1, 2, 3, 5-year survival rates were 96.2%, 89.7%, 83.3% and 71.8% respectively. Emergence of early radiation reactions can tolerate, during the follow-up showed no obvious difficulty in mouth or cranial nerve injury in the latter group. Conclusion Nasopharyngeal carcinoma three-dimensional conformal radiotherapy plus conventional radiation treatment of long-term efficacy is sure.