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目的通过调查我院单纯根治性放射治疗的鼻咽癌患者,根据放射治疗后复发转移的情况,提出鼻咽癌临床放射治疗分型,总结其分布规律。方法随机抽取20世纪90年代在中山大学肿瘤防治中心行单纯根治性放疗鼻咽癌住院病人842例,根据5年的随访结果,无原发部位和区域淋巴结复发及无远处转移设定为辐射敏感不易转移型(Ⅰ型)、有原发部位或区域淋巴结复发及无远处转移定为辐射抗拒不易转移型(Ⅱ型)、无原发部位和区域淋巴结复发及有远处转移定为辐射敏感易转移型(Ⅲ型)、有原发部位或区域淋巴结复发及有远处转移定为辐射抗拒易转移型(Ⅳ型),分析4种临床放射治疗分型的分布规律以及4种分型与谢志光分型之间的联系。结果(1)4种分型的比例为辐射敏感不易转移型50·6%(426例),辐射抗拒不易转移型23·2%(195例),辐射敏感易转移型20·7%(174例)和辐射抗拒易转移型5·6%(47例)。(2)842例患者中有264例可按谢氏分型标准进行分型,其中上行型24·6%(65例),下行型23·1%(61例),混合型52·3%(138例);上行型中:Ⅰ型58·5%,Ⅱ型29·2%,Ⅲ型10·8%,Ⅳ型1·5%;下行型中:Ⅰ型47·5%,Ⅱ型9·8%,Ⅲ型36·1%,Ⅳ型6·6%;混合型中:Ⅰ型34·8%,Ⅱ型26·8,Ⅲ型33·3%,Ⅳ型5·1%。(3)92临床分期早期(Ⅰ、Ⅱ期)有307例,Ⅰ型62·2%(191例),Ⅱ型21·2%(65例),Ⅲ型12·4%(38例),Ⅳ型4·2%(13例);晚期(Ⅲ、Ⅳ期)有535例,Ⅰ型43·9%(235例),Ⅱ型24·3%(130例),Ⅲ型25·4%(136例),Ⅳ型6·4%(34例)。结论在鼻咽癌中存在上述4种放射治疗分型,其构成比为:放射敏感不易转移型(Ⅰ型)>放射抗拒不易转移型(Ⅱ型)>放射敏感易转移型(Ⅲ型)>放射抗拒易转移型(Ⅳ型),在谢氏的下行型和混合型中及92福州临床分期晚期(Ⅲ、Ⅳ期)中,放射敏感易转移型(Ⅲ型)的比例大于放射抗拒不易转移型(Ⅱ型),放射治疗分型是对鼻咽癌临床分型及分期的补充。
Objective To investigate the distribution of clinical radiation therapy for nasopharyngeal carcinoma (NPC) by investigating patients with nasopharyngeal carcinoma treated by simple radical radiotherapy in our hospital and according to the recurrence and metastasis after radiotherapy. Methods Totally 842 inpatients with nasopharyngeal carcinoma were randomly selected from Sun Yat-sen University Cancer Center in the 1990s. According to the 5-year follow-up results, no primary site and regional lymph node recurrence and no distant metastasis were set as radiation Sensitive type is not easy to transfer (type Ⅰ), with primary site or regional lymph node recurrence and no distant metastasis as radiation-resistant non-metastable type (Ⅱ), no primary site and regional lymph node recurrence and distant metastasis as radiation Sensitive and easily metastable type (Ⅲ), with primary site or regional lymph node recurrence and distant metastasis as radiation-resistant easy to transfer type (Ⅳ), analysis of the distribution of the four clinical radiation therapy typing and four types And Xie Zhiguang the connection between the type. Results (1) The proportion of the four subtypes was 50.6% (426 cases) with radiosensitive non-metastable type, 23.2% (195 cases) with non-radiative refractory disease, and 20.7% (174% Cases) and radiation resistant easy to transfer type 5.6% (47 cases). (2) 264 of 842 patients were classified according to the Xie’s classification criteria, including 24.6% of the up-going type, 65.1% of the down-type type, 61.3% of the down- (138 cases). In the ascending type, type I was 58.5%, type II was 29.2%, type III was 10.8%, type IV was 1.5%, type I was 47.5%, type II 9.8% of type Ⅲ, 36.1% of type Ⅲ, and 6.6% of type Ⅳ. In the mixed type, 34.8% of type Ⅰ, 26.8% of type Ⅱ, 33.3% of type Ⅲ and 5.1% of type Ⅳ were found. There were 307 cases of type I and 62.2% of the patients in the early clinical stage (stage I and II), 21.2% of the type II patients (65 cases), and 12.4% of the type III patients (38 cases) Ⅳ type 4 · 2% (13 cases); advanced stage (Ⅲ, Ⅳ) 535 cases, type Ⅰ 43.9% (235 cases), type Ⅱ 24.3% (130 cases), type Ⅲ 25.4% (136 cases), type Ⅳ 6.4% (34 cases). CONCLUSIONS: There are four types of radiotherapy in nasopharyngeal carcinoma, and their constituent ratios are: radiosensitive not metastable type (type I)> radiosensitive non-metastatic type (type II)> radiosensitive transferable type (type III) Radiation resistant easy to transfer type (Ⅳ type), in Xie’s descending and mixed type 92 late phase of Fuzhou clinical stage (Ⅲ, Ⅳ), the ratio of radiation-sensitive easily transferable type (Ⅲ) is greater than the radiation resistance is not easy to transfer Type (type Ⅱ), radiation therapy typing is the clinical classification and staging of nasopharyngeal carcinoma.