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[目的]总结常规放疗技术和治疗策略变化对鼻咽癌放射治疗后生存率的影响。[方法]1989年9月至2007年2月间,首程治疗鼻咽癌3227例。按治疗技术的演变分为3个阶段。第1阶段,1989年至1995年,60Co治疗,规则野照射,耳前野+前颈切线野;第2阶段,1996年至2001年,直线加速器或60Co治疗,面罩固定低熔点铅不规则野照射,面颈联合野DT36～40Gy后改面颈分野,或面颈联合野后界避开脊髓,后上颈部用电子线照射;第3阶段,2002年至2007年,病人CT模拟定位,TPS设计,DVH评价治疗计划,直线加速器低熔点铅或MLC不规则野照射。同时对N2～3期病人同期化疗,大部分病人用PF方案(DDP+5-Fu)。[结果]随访结果,5年和10年总生存率,第1阶段为54.2%和47.2%,第2阶段为64.5%和54.6%,第3阶段的5年总生存率为71.1%。3个阶段的总生存率差异有统计学意义(χ2=45.877,P=0.000)。局部晚期即Ⅲ～Ⅳ期的病人占所有病人的比例,第1个治疗阶段为83.8%,第2个治疗阶段为70.2%,第3个治疗阶段为73.9%。Ⅲ期病人5年总生存率比较,第1阶段为病人57.6%,第2阶段为61.7%,第3阶段为66.7%(χ2=6.510,P=0.039)。Ⅳ期病人总生存率比较,第1阶段为34.3%,第2阶段为45.0%,第3阶段为53.8%(χ2=22.289,P=0.000)。[结论]近20年来鼻咽癌治疗治疗技术和治疗策略演变进步,显著提高了治疗后病人的生存率。
[Objective] To summarize the influence of routine radiotherapy technique and treatment strategy on the survival rate of nasopharyngeal carcinoma after radiotherapy. [Method] Between September 1989 and February 2007, 3227 nasopharyngeal carcinomas were treated for the first time. According to the evolution of treatment technology is divided into three stages. Stage 1, 1989-1995, 60Co treatment, regular field irradiation, otoplasty + anterior neck tangential field; stage 2, 1996-2001, linear accelerator or 60Co treatment, masks fixed low melting lead irregular field irradiation , The facial and cervical joint field DT36 ~ 40Gy changed face neck, or facial and neck joint field to avoid the spinal cord after the upper neck with electron beam irradiation; the third stage, from 2002 to 2007, the patient CT simulation positioning, TPS Design, DVH Evaluation Treatment Plan, Linear Accelerator Low Melting Point Lead or MLC Irregular Field Irradiation. At the same time N2 ~ 3 patients with concurrent chemotherapy, most patients with PF program (DDP +5-Fu). [Results] The follow-up results showed that the 5-year and 10-year overall survival rates were 54.2% and 47.2% in stage 1, 64.5% and 54.6% in stage 2, and 71.1% in stage 3, respectively. The 3-year overall survival rate was statistically significant (χ2 = 45.877, P = 0.000). The proportion of patients with locally advanced stage III-IV was 83.8% in the first treatment stage, 70.2% in the second treatment stage, and 73.9% in the third treatment stage. The 5-year overall survival of stage III patients was 57.6% in stage 1, 61.7% in stage 2 and 66.7% in stage 3 (χ2 = 6.510, P = 0.039). The overall survival of stage IV patients was 34.3% in stage 1, 45.0% in stage 2 and 53.8% in stage 3 (χ2 = 22.289, P = 0.000). [Conclusion] The evolution and treatment of nasopharyngeal carcinoma treatment and treatment strategy and treatment strategy in recent 20 years have significantly improved the survival rate of patients after treatment.