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目的:回顾性分析早中期鼻咽癌长期生存者正常组织晚期损伤的相关因素,探讨常规放疗条件下减少晚期损伤的方法。方法:收集在门诊复查的2000-03-06-2002-12-20本院收治的Ⅰ～Ⅱ期初治鼻咽癌患者183例,为非连续病例。全组病例均用6MVX射线行外照射。鼻咽部设野采用面颈联合野照射103例,耳前野照射80例,颈部采用切线野照射。鼻咽部照射剂量≤70Gy150例,>70Gy33例,中位剂量70Gy(64～82Gy)。颈部照射剂量≤50Gy45例,>50Gy138例,中位剂量68Gy(49～85Gy)。结果:当鼻咽部照射剂量≤70Gy或>70Gy时,晚期损伤分别为口干91.3%(137/150)、100.0%(33/33),张口困难48.0%(72/150)、81.8%(27/33),放射性颞叶损伤14.7%(22/150)、36.4%(12/33),后组颅神经损伤17.3%(26/150)、42.4%(14/33)。当颈部剂量≤50Gy或>50Gy时,晚期损伤分别为:颈纤维化22.2%(10/45)、63.8%(88/138),后组颅神经损伤11.1%(5/45)、25.4%(35/138)。照射剂量与晚期损伤呈明显正相关。结论:二野照射方法剂量分布不合理,是造成早中期鼻咽癌正常组织迟发反应的主要原因。采用后装腔内放疗、鼻前野或鼻前面颈联合野等的方法有望减少危及器官的损伤。
OBJECTIVE: To retrospectively analyze the related factors of late injury of early-stage nasopharyngeal carcinoma (NPC) patients with normal tissue and to explore the methods of reducing the late damage under routine radiotherapy conditions. Methods: A total of 183 patients with nasopharyngeal carcinoma in stage Ⅰ ~ Ⅱ admitted to our hospital for review from 2000-03-06-2002-12-20 were non-consecutive cases. All patients were treated with 6MVX external radiation. Nasopharynx set up field with face-neck joint field irradiation in 103 cases, 80 cases of ear field irradiation, the neck using tangent field irradiation. Nasopharyngeal irradiation dose ≤ 70Gy150 cases,> 70Gy33 cases, the median dose of 70Gy (64 ~ 82Gy). Neck irradiation dose ≤ 50Gy45 cases,> 50Gy138 cases, the median dose of 68Gy (49 ~ 85Gy). Results: The late damage was 91.3% (137/150), 100.0% (33/33), 48.0% (72/150) and 81.8% (85%) when nasopharyngeal irradiation dose was less than or equal to 70Gy 27/33), 14.7% (22/150) and 36.4% (12/33) of the radiation temporal lobe injury, and 17.3% (26/150) and 42.4% (14/33) of the cranial nerve injury in the latter group. When the neck dose was less than or equal to 50Gy, the advanced injuries were 22.2% (10/45), 63.8% (88/138) for neck fibrosis, 11.1% (5/45) for the posterior cranial nerve injury, 25.4% (35/138). Exposure dose and late injury was significantly positively correlated. Conclusion: The dose distribution of Erye irradiation method is unreasonable, which is the main reason of the delayed reaction of normal tissues in early and mid-stage NPC. The use of posterior chamber radiotherapy, nasal anterior or nasal anterior neck joint field is expected to reduce the risk of organ damage.