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目的:比较常规外照射前后三维适形放射治疗初治鼻咽癌对预后和生存质量的影响。方法:419例初治鼻咽癌随机分组对照研究,按92福州分期标准,Ⅰ、Ⅱ、Ⅲ和ⅣA期分别为23、166、141和89例,其中209例常规外照射50Gy后三维适形放射治疗(2D+3D组),210例三维适形放射治疗后常规外照射(3D+2D组),两组治疗剂量、分割方式和总周期基本相同。结果:2D+3D和3D+2D组2～5年局部控制率分别为94.3%、87.1%、83.5%、80.8%和93.7%、89.1%、86.7%、85.5%,χ2值分别为0.056、0.203、0.34和0.419,P值分别为0.833、0.677、0.579和0.522;1、3、5年总生存率分别为96.0%、76.9%、71.2%和95.7%、80.7%、76.4%,χ2值分别为0.06、0.497和0.376,P值分别为0.831、0.487和0.553;两组局部控制率和总生存率随着时间延长差距有加大趋势,2D+3D组下降速度相对较快,3D+2D组在3年后相对平缓。两组口干、张口困难发生率和程度差异无统计学意义,χ2值分别为0.0294、0.0452,P值分别为0.882、0.853。结论:二维治疗前实施三维治疗在不显著增加毒副反应的前提下,有提高局部控制率和总生存率的趋势,继续随访有望得到更乐观的结果。
OBJECTIVE: To compare the effect of three-dimensional conformal radiotherapy (NPC) on the prognosis and quality of life of nasopharyngeal carcinoma before and after conventional external beam irradiation. Methods: A total of 419 newly diagnosed nasopharyngeal carcinoma patients were randomly divided into two groups. According to 92 Fuzhou staging criteria, 23,166,141 and 89 cases were treated with stage Ⅰ, Ⅱ, Ⅲ and ⅣA, respectively. Radiotherapy (2D + 3D group) and conventional external beam irradiation (3D + 2D group) of 210 cases after 3D conformal radiotherapy, the treatment dose, division mode and total cycle of the two groups were basically the same. Results: The local control rates of 2 ~ 5 years in 2D + 3D and 3D + 2D groups were 94.3%, 87.1%, 83.5%, 80.8% and 93.7%, 89.1%, 86.7% and 85.5% respectively, and the χ2 values were 0.056 and 0.203 , 0.34 and 0.419 respectively, with P values of 0.833, 0.677, 0.579 and 0.522 respectively. The overall survival rates at 1, 3 and 5 years were 96.0%, 76.9%, 71.2% and 95.7%, 80.7% and 76.4%, respectively 0.06,0.497 and 0.376, P values were 0.831, 0.487 and 0.553 respectively. The local control rate and overall survival rate of both groups tended to increase with the increase of time lag, and the descending speed of 2D + 3D group was relatively fast. 3 years after the relatively flat. There was no significant difference in the incidence and extent of dry mouth and mouth opening between the two groups, with χ2 values of 0.0294 and 0.0452, respectively, with P values of 0.882 and 0.853, respectively. Conclusion: The two-dimensional treatment before the implementation of three-dimensional treatment without significant increase in toxicity under the premise of improving the local control rate and overall survival trend, follow-up is expected to be more optimistic results.