论文部分内容阅读
[目的]探讨局部残留和复发鼻咽癌分次立体定向放射治疗(FSRT)靶区设定的合理性以及局部控制的影响因素。[方法]1999年9月至2005年12月,90例局部残留(34例)和复发(54例)鼻咽癌患者接受FSRT治疗,肿瘤最大径和体积范围分别为1.8～6.2cm(中位3.4cm)和0.8～24.7cm3(中位5.7cm3);计划靶区(PTV)定义为增强CT上的强化病灶外加2～3mm边缘,残留和复发病变的FSRT中位处方剂量分别为18Gy/3次和48Gy/6次。[结果]中位随访时间24.9个月(3.3～86.3个月),局部复发14例,其中,野内复发7例,86%(6/7)原病灶最大径<4cm;野外复发6例,67%(4/6)原病灶最大径>4cm;野内和野外同时复发1例。2和4年局部无失败生存率分别为83.1%和75.7%。肿瘤最大径>4cm和第2次局部复发者的4年局部无失败生存率均明显低于肿瘤最大径≤4cm(55.2%vs.82.1%,P=0.0369)和第1次局部复发和残留者(0vs.83.5%,P=0.0003)。[结论]对局部残留和复发鼻咽癌FSRT的靶区设定基本上是合理的,但对直径较大的肿瘤,PTV应适当扩大或改用其它治疗;肿瘤最大径>4cm或第二次局部复发的患者,其局部控制效果不佳。
[Objective] To explore the rationality of local target setting of fractional and stereotactic radiotherapy (FSRT) for local residual and recurrent nasopharyngeal carcinoma and the influential factors of local control. [Methods] From September 1999 to December 2005, 90 patients with locally residual (34 cases) and recurrent (54 cases) nasopharyngeal carcinoma underwent FSRT. The maximum diameter and volume range of tumors were 1.8 ~ 6.2cm (median 3.4 cm) and 0.8 to 24.7 cm 3 (median 5.7 cm 3). The planned target area (PTV) was defined as the median prescribing dose of 18 Gy / 3 for enhanced lesions on CT plus 2 to 3 mm margins, residual and recurrent lesions Times and 48Gy / 6 times. [Results] The median follow-up time was 24.9 months (3.3-86.3 months). There were 14 cases of local recurrence. Among them, 7 cases were in field and 86% (6/7) % (4/6) the largest diameter of the original lesions> 4cm; field and field at the same time recurrence in 1 case. The 2-and 4-year local failure-free survival rates were 83.1% and 75.7%, respectively. The 4-year local failure-free survival rates of tumors with a maximum diameter> 4 cm and those with a second local recurrence were significantly lower than those with a maximum tumor diameter ≤ 4 cm (55.2% vs 82.2%, P = 0.0369) and the first recurrence and residual (0 vs. 83.5%, P = 0.0003). [Conclusion] The target setting of FSRT for local residual and recurrent nasopharyngeal carcinoma is basically reasonable. However, for tumors with larger diameter, PTV should be appropriately expanded or switched to other treatments. The maximum diameter of tumors> 4cm or the second Local recurrence of patients with poor local control.