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目的回顾性分析和评价局部复发鼻咽癌调强放疗的临床结果和预后因素。方法共132例进入分析,其中男104例,女28例,中位年龄44．5岁(21～73岁)。全组中位复发时间为24个月(6～184个月)。依1992年福州分期标准再进行临床分期,Ⅰ、Ⅱ、Ⅲ、Ⅳa期分别为5、14、29、84例。其中T1、T2、T3、T4期各7、14、30、81例。22例同时伴有颈淋巴结复发。鼻咽大体肿瘤体积(GTV)处方剂量60～70 Gy,分次剂量1．94～2．80 Gy。60例接受了2～6个疗程的化疗。结果GTV中位体积为39．5cm~3(0．8～158．9 cm~3),治疗计划显示平均D95和V95分别达66．9 Gy和98．3%,平均剂量和分次剂量均值分别为69．8、2．32 Gy。全组中位随访时间12个月(2～47个月)。1、2、3年局部无进展生存率和总生存率分别为96．4%、88．4%、85．3%和65．9%、49．6%、41．6%。11例治疗后发生远处转移。47例治疗后出现鼻咽坏死或大出血,死亡57例。单因素及多因素分析显示分次剂量(P=0．016)和GTV体积(P=0．009)显著影响了患者的生存时间。结论IMRT可提高复发鼻咽癌患者的局部控制率和生存率。分次剂量和GTV体积为影响患者生存时间的独立预后因素。复发鼻咽癌治疗后的主要死亡原因为鼻咽坏死和大出血。
Objective To retrospectively analyze and evaluate the clinical outcome and prognostic factors of local recurrence of nasopharyngeal carcinoma with intensity modulated radiotherapy. Methods A total of 132 cases were included in the analysis, including 104 males and 28 females, with a median age of 44.5 years (21-73 years). The median time to recurrence was 24 months (6 to 184 months). According to the 1992 staging of Fuzhou staging again, Ⅰ, Ⅱ, Ⅲ, Ⅳa were 5,14,29,84 cases. Of which T1, T2, T3, T4 of the 7,14,30,81 cases. Twenty-two patients were accompanied by cervical lymph node recurrence. Nasopharyngeal gross tumor volume (GTV) prescription dose of 60 ~ 70 Gy, sub-dose 1.94 ~ 2.80 Gy. 60 patients received 2 to 6 courses of chemotherapy. Results The median volume of GTV was 39.5 cm ~ 3 (0.8 ~ 158.9 cm ~ 3). The treatment plan showed that the mean D95 and V95 reached 66.9 Gy and 98.3% respectively. The mean and median dose of GTV Respectively, 69.8,2.32 Gy. The median length of follow-up was 12 months (range 2-47 months). The rates of progression-free survival and overall survival at 1, 2 and 3 years were 96.4%, 88.4%, 85.3% and 65.9%, 49.6% and 41.6%, respectively. 11 cases of distant metastasis occurred after treatment. 47 cases of nasopharyngeal necrosis or bleeding after treatment, 57 patients died. Univariate and multivariate analyzes showed that split dose (P = 0.016) and GTV volume (P = 0.009) significantly influenced patient survival. Conclusion IMRT can improve the local control rate and survival rate of patients with recurrent nasopharyngeal carcinoma. Fractional doses and GTV volume are independent prognostic factors that influence patient survival. The main causes of death after nasopharyngeal cancer treatment for nasopharyngeal necrosis and bleeding.