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目的 :探讨后程加速超分割能否较常规分割具有更好的鼻咽原发灶局部控制率 ,相应地提高生存率。同时观察急性和后期放射反应。方法 :15 6例经病理确诊的鼻咽鳞状细胞癌初次治疗患者 (T1 4N0 2M 0 ) ,按 92分期T1、T2、T3、T4分层 ,随机分入常规分割组 (对照组 )和后程加速超分割组 (研究组 )接受根治性放射治疗。随访中位时间 38个月 (2 2～ 6 5个月 ) ,可评价病例 15 4例。对照组 (80例 ) 180～ 193cGy/次·d-1,5d/周 ,鼻咽原发灶中位肿瘤总剂量 72 90cGy/ 39次 ,5 5d ;研究组 (74例 )放疗分两个阶段 ,第一阶段常规分割照射 ,181～ 196cGy/次·d-1,5d/周 ,剂量 40 0 0cGy/ 2 1次 ;第二阶段 15 0cGy/次 ,2次 /d ,两次照射相隔≥ 6h ,5d/周 ,每天的第二次照射用缩野技术。鼻咽原发灶中位肿瘤总剂量 735 9cGy/ 43次 ,46d。颈部根治性照射中位肿瘤总剂量 6 5 6 4cGy/ 37次 ,5 3d ,颈部预防照射中位肿瘤量 5 5 5 7cGy/ 31次 ,46d。结果 :末次随访时 ,对照组有 1例未控、8例鼻咽复发 ,研究组有 2例鼻咽复发 ,3年鼻咽局部控制率分别为 88.5 %、96 % (P =0 .0 3) ;对照组和研究组分别有 14和 13例发生远处转移 ,其中N2病例占 6 7% (18/ 2 7) ,3年生存率、无瘤生存率分别为 80 %、6 7.2 %和 88.6 %、77.9% ,而?
OBJECTIVE: To investigate whether late-stage accelerated hyperfractionation has better local control rate of primary nasopharyngeal lesions than conventional segmentation and correspondingly improve survival rate. Simultaneous observation of acute and late radiation reactions. Methods: Fifty-six primary nasopharyngeal squamous cell carcinoma patients (T1 4N0 2M 0) were pathologically diagnosed. The patients were divided into two groups according to 92 stages of T1, T2, T3 and T4. The patients were randomly divided into two groups: control group, Cheng accelerated hyperfractionation group (study group) received radical radiotherapy. The median follow-up time was 38 months (22 to 65 months) and 15 4 evaluable cases. The control group (80 cases) 180 ~ 193cGy / times · d-1, 5d / week, the total dose of the median tumor in the primary tumor of nasopharynx 72 90cGy / 39 times, 5 5d; study group (74 cases) radiotherapy in two stages , The first stage of routine irradiation, 181 ~ 196cGy / times · d-1, 5d / week, the dose of 40 0cGy / 2 1; the second stage of 15 0cGy / times, 2 times / d, , 5d / week, the second day of irradiation with shrinking technology. The median tumor of the primary tumor of the nasopharynx was 735 9cGy / 43 times, 46 days. The median dose of radical neoplasms in the neck was 6546cGy / 37 times, 5 days, and the median neoplasia of the neck was 577cGy / 31 times, 46 days. Results: In the last follow-up, one case was uncontrolled in the control group and eight cases of nasopharyngeal recurrence. Two cases of nasopharyngeal recurrence were found in the study group. The three-year nasopharyngeal local control rates were 88.5% and 96% (P = 0. 03, respectively ). There were 14 and 13 cases of distant metastasis in the control group and the study group, respectively. Of them, N2 cases accounted for 67% (18/27), 3-year survival rates and tumor-free survival rates were 80% and 62.2% 88.6%, 77.9%, while?