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目的回顾性分析鼻咽癌后程非常规分割放疗后的效果和失败因素。方法133例初治鼻咽低分化鳞癌患者进入研究。采用6MVX线照射,原发灶先面颈野常规放疗34.56Gy(1.92Gy/次,1次/d,共18d);后缩野为耳前野加速分割放疗1.25～1.50Gy/次,2次/d,6～8d;再后为耳前野加小野补量1.90Gy/次(上午)与1.30Gy/次(下午),2次/d,6～8d;2次间隔时间≥6h,5d/周。病灶中位剂量78Gy,中位时间47d。颈部淋巴结有转移的常规放疗67Gy,无转移的常规放疗50～55Gy,中位时间43d。结果T1、T2、T3、T4期局部控制率分别为100%、96.6%、96.6%、78.4%,全组5年总生存率和无瘤生存率分别为73.3%和70.8%。共14项因素用于临床预后分析,其中单因素有8项对5年生存率有影响(P<0.01),Cox多因素分析远处转移、下颈和锁骨上以及双侧颈淋巴结转移、鼻咽复发均有统计学意义(P值分别为0.000、0.016、0.044、0.041)。结论鼻咽原发灶和颈淋巴结转移灶局部控制率和生存率均较过去提高,治疗失败和死亡的主要原因是远处转移。
Objective To retrospectively analyze the effect and failure factors of unconventional segmental radiotherapy of nasopharyngeal carcinoma. Methods 133 newly diagnosed nasopharyngeal poorly differentiated squamous cell carcinoma patients were enrolled. Using 6MVX line irradiation, the primary tumor of the neck in front of the routine routine radiotherapy 34.56Gy (1.92Gy / time, 1 time / d, a total of 18d); after the reduction of the ear to the anterior segment accelerated radiotherapy 1.25 ~ 1.50Gy / time, 2 times / d, 6 ~ 8d; then the amount of antelora plus the amount of oncology 1.90Gy / time (morning) and 1.30Gy / time (afternoon), 2 times / d, 6 ~ 8d; 2 times interval of 6h, 5d / . The median dose of lesions 78Gy, the median time 47d. Cervical lymph node metastasis of conventional radiotherapy 67Gy, without transfer of conventional radiotherapy 50 ~ 55Gy, the median time 43d. Results The local control rates of T1, T2, T3 and T4 were 100%, 96.6%, 96.6% and 78.4% respectively. The overall 5-year overall survival and tumor-free survival rates were 73.3% and 70.8% respectively. A total of 14 factors were used in the clinical prognosis analysis. Among them, 8 of the single factors had an impact on the 5-year survival rate (P <0.01), Cox multivariate analysis of distant metastasis, supraclavicular and supraclavicular and bilateral cervical lymph node metastasis, nasal Pharyngeal recurrence was statistically significant (P values were 0.000,0.016,0.044,0.041). Conclusion The local control rate and survival rate of primary nasopharyngeal and cervical lymph node metastases are higher than before. The main reason of failure and death is distant metastasis.