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目的探讨后程加速超分割放射治疗晚期鼻咽癌的临床疗效,同时观察急性放疗反应和后遗症。方法92例Ⅲ、Ⅳa期鼻咽癌患者随机分为常规分割放射治疗组(常规组)46例和后程加速超分割放射治疗组(后超组)46例,常规组2.0G y/次,1次/d,5次/周,总剂量(74￣78)G y/(7.4￣7.8)周,后超组前3.5￣4周照射同常规组,放疗至36￣40G y后改为1.5G y/次,2次/d,间隔6￣8h,5d/周,总剂量(72￣78)G y/(7.2￣7.8)周。结果两组病例3年鼻咽原发灶控制率分别为69.6%和87.0%,差异有显著性意义(P<0.05),3年生存率分别为67.4%、76.1%,差异无显著性意义(P>0.05),3年累积远处转移发生率分别为32.6%和26.1%,差异无显著性意义(P>0.05)。两组颈淋巴结控制率相仿;两组急性黏膜放射反应和正常组织后期放射反应相仿。结论后程加速超分割放射治疗较常规分割放射治疗提高了Ⅲ、Ⅳa期鼻咽癌3年鼻咽原发灶控制率,不能提高3年生存率,两组急性放射反应相似,后期放射反应相仿,有必要扩大病例并作长期随访研究。
Objective To investigate the clinical effect of late-course accelerated hyperfractionation radiotherapy for advanced nasopharyngeal carcinoma (NPC) and to observe acute radiotherapy and sequelae. Methods Ninety-two patients with stage Ⅲa and Ⅳa nasopharyngeal carcinoma were randomly divided into routine radiotherapy group (n = 46) and accelerated radiofrequency ablation group (n = 46) The total dose (74-78) Gy / (7.4-7.8) weeks, 3.5 to 4 weeks after the super-group before irradiation were the same as those in the conventional group. The radiotherapy was changed to 1.5 after 36-40 Gy G y / time, 2 times / d, 6 to 8 h intervals, 5 d / week, total dose (72 to 78) Gy / (7.2 to 7.8) weeks. Results The three-year primary nasopharyngeal control rates in two groups were 69.6% and 87.0% respectively (P <0.05), and the 3-year survival rates were 67.4% and 76.1% respectively, with no significant difference P> 0.05). The incidence of 3-year cumulative distant metastasis was 32.6% and 26.1%, respectively, with no significant difference (P> 0.05). Two groups of cervical lymph node control rate similar; two groups of acute mucosal radiation response and normal tissue late radiation similar. Conclusions Post-course accelerated hyperfractionation radiotherapy can improve the control rate of primary nasopharyngeal carcinoma in stage III and IVa nasopharyngeal carcinoma for 3 years compared with conventional fractionated radiotherapy, and can not improve the 3-year survival rate. The acute radiotherapy responses in both groups are similar, , It is necessary to expand the case and long-term follow-up study.