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目的分析鼻咽癌治疗失败的主要原因并探讨提高生存率的方法。方法1988年4月至1991年12月,共收治鼻咽癌265例,其中Ⅰ期5例,Ⅱ期73例,Ⅲ期113例,Ⅳ期74例,年龄13~78岁。采取60Co及深部X线照射。原发灶剂量60~80Gy/6~8WKs,颈转移灶55~74Gy/5~7WKs。对N2和N3中分单放与放疗前DDP,5-Fu诱导化疗。随机分组各50例。结果总5年生存率38.5%。Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为80.0%、61.6%、36.3%、16.2%。局部复发和远处转移是治疗失败的主要原因。结论早期诊治是提高生存率的关键,减少原发灶复发应以CT为准。合理设计照射野,建议将常规耳前野的后界延至外耳孔后缘1~2厘米;对超腔、累及口咽、咽旁间隙、茎突后间隙及伴颈深上淋巴结转移者尽量使用面颈联合野,放疗前诱导化疗对N2和N3病例近期疗效满意。
Objective To analyze the main causes of treatment failure in nasopharyngeal carcinoma and to explore ways to improve survival. Methods From April 1988 to December 1991, a total of 265 cases of nasopharyngeal carcinoma were treated, including 5 cases in stage I, 73 cases in stage II, 113 cases in stage III, 74 cases in stage IV, and ages from 13 to 78 years. Take 60Co and deep X-rays. The primary tumor dose was 60-80 Gy/6-8 WKs, and the cervical metastases were 55-74 Gy/5-7 WKs. N2 and N3 were divided into single radiotherapy and radiotherapy before DDP, 5-Fu induction chemotherapy. Randomly grouped 50 cases. The overall 5-year survival rate was 38.5%. Phases I, II, III, and IV were 80.0%, 61.6%, 36.3%, and 16.2%, respectively. Local recurrence and distant metastasis are the main reasons for treatment failure. Conclusions Early diagnosis and treatment is the key to improve survival rate. The reduction of primary tumor recurrence should be based on CT. Reasonably designing the radiation field, it is recommended to extend the posterior boundary of the conventional preauricular field to the posterior edge of the outer ear hole by 1 to 2 cm; use the surface as far as possible for the hypercavity, involving the oropharynx, parapharyngeal space, posterior styloid process space, and cervical lymph node metastasis. Neck combined fields and induction chemotherapy before radiotherapy were satisfactory for the short-term effects of N2 and N3 cases.