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[目的]探讨颅底受累鼻咽癌常规放疗后颅底推量的临床价值。[方法]2000年1月至2001年12月经病理学确诊、影像学证实有颅底骨质破坏、常规放疗剂量为68～72Gy的初治鼻咽癌患者共497例,其中,120例于放疗结束时即予双侧颅底野推量6～12Gy(推量组),377例无颅底推量(无推量组)。局控率、总生存率及神经系统放射性并发症发生率为主要评价指标。[结果]中位随访时间60.7个月(5.1～109.5个月)。两组5年鼻咽控制率、颅底颅内控制率、总生存率和无颅神经损伤发生率比较均无显著性差异,但推量组的5年无颞叶坏死发生率明显低于无推量组(71.4%vs91.1%,P<0.001)。以蝶窦、海绵窦、筛窦侵犯和T3、T4期作为5个亚组进行分析,结果显示颅底推量均不能提高各亚组的颅底颅内控制率和总生存率。[结论]常规放疗后采用颅底野对颅底受累的鼻咽癌患者推量的方法未能获得局控率和总生存率的改善,但可使放射性颞叶坏死发生率明显增加。
[Objective] To investigate the clinical value of cranial base thrust after conventional radiotherapy for nasopharyngeal carcinoma of the skull base. [Methods] From January 2000 to December 2001, 497 cases of newly diagnosed nasopharyngeal carcinoma patients were diagnosed by pathology and confirmed by skull base imaging. The conventional radiotherapy dose was 68 ~ 72 Gy. Among them, 120 cases were treated with radiotherapy At the end of that time to the bilateral skull base field thrust volume 6 ~ 12Gy (thrust volume group), 377 patients without skull base thrust volume (no thrust volume group). Bureau control rate, total survival rate and the incidence of neurological radiation complications as the main evaluation index. [Results] The median follow-up time was 60.7 months (5.1-109.5 months). There was no significant difference in the 5-year nasopharyngeal control rate, intracranial skull base control rate, overall survival rate and cranial nerve injury incidence between the two groups, but the incidence of 5-year absence of temporal lobe necrosis in the thrust volume group was significantly lower than that of the no-thrust Group (71.4% vs 91.1%, P <0.001). Sphenoid sinus, cavernous sinus, ethmoid sinus invasion and T3, T4 phase as a subgroup analysis of 5, the results showed that the amount of cranial base thrust can not improve the sub-group intracranial cranial control and overall survival rate. [Conclusion] The method of using the skull base field to push the skull base involved NPC after conventional radiotherapy fails to get the improvement of the local control rate and the overall survival rate, but it can obviously increase the incidence of radioactive temporal lobe necrosis.