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目的:探讨鼻咽癌后程加速超分割放射治疗(LCAF)的近期疗效和毒性反应。方法:;对182例中晚期鼻咽癌随机抽签分2个组,CF 组和 LCAF 组。CF 组鼻咽部和颈部全程行常规分割放疗,即每周放疗5天,每日1次,每次2Gy,鼻咽部及颈部分别给予根治剂量65～75Gy,45～55天完成。LCAF 组第一阶段(疗程前3.5周)常规放疗,肿瘤量36Gy,第二阶段(后3.0周)鼻咽部采用 LCAF,即每周放疗5天、每日二次、每次1.2～1.3Gy,两次间隔时间6～8小时,加速照射剂量为30～35Cy,颈部分割方法同 CF 组,鼻咽部及颈部总剂量分别为65～75Gy,41～47天完成。有颈部淋巴结转移者照射到68～74Gy,6.5～7.5周完成,临床上未扪及淋巴结者预防照射到55～60Gy,5.5～6.0周完成。结果:治疗结束时 CF 组肿瘤完全消失、缩小和无效者分别为51.09%、35.87%和13.04%,而LCAF 组分别为66.67%、28.89%和4.44%,两者肿瘤全消率差异有显著性意义(χ~2=4.195,P<0.05),LCAF 组的Ⅰ、Ⅱ、Ⅲ度急性放射反应发生率分别27.78%、44.44%、27.78%而 CF 组分别为38.04%、42。39%、19.56%,两组差异无显著性意义,(χ~2=1.70,P>0.05)。结论:LCAF 放射治疗可以改善中晚期鼻咽癌的局部控制率,而不增加急性放射反应,LCAF 能否改善长期生存率,还需进一步积累病例和深入研究。
Objective: To investigate the short-term effect and toxicity of late-stage accelerated hyperfractionation radiotherapy (LCAF) for nasopharyngeal carcinoma. Methods: 182 patients with advanced nasopharyngeal carcinoma were randomized into 2 groups, CF group and LCAF group. CF group nasopharyngeal and neck routine routine radiotherapy, that is, 5 days a week, once a day, every 2Gy, nasopharyngeal and neck were given a radical dose of 65 ~ 75Gy, 45 to 55 days to complete. In the first phase of LCAF group (3.5 weeks before the course of treatment), the amount of tumor was 36 Gy. In the second stage (after 3.0 weeks), LCAF was used in the nasopharynx, ie, weekly radiotherapy for 5 days and twice daily for 1.2 to 1.3 Gy , Two time intervals of 6 to 8 hours, accelerated irradiation dose of 30 ~ 35Cy, the total number of neck segmentation method with CF group, nasopharyngeal and neck were 65 ~ 75Gy, 41 ~ 47 days to complete. Cervical lymph node metastasis to 68 ~ 74Gy, 6.5 ~ 7.5 weeks to complete the clinical non-palpable lymph node irradiation prevention to 55 ~ 60Gy, 5.5 to 6.0 weeks to complete. Results: At the end of treatment, the tumors completely disappeared, reduced and ineffective in CF group were 51.09%, 35.87% and 13.04%, respectively, while those in LCAF group were 66.67%, 28.89% and 4.44% respectively. There was significant difference between the two groups (Χ ~ 2 = 4.195, P <0.05). The incidences of I, II and III acute radiation in LCAF group were 27.78%, 44.44% and 27.78% respectively, while those in CF group were 38.04%, 42.39% and 19.56 %, No significant difference between the two groups, (χ ~ 2 = 1.70, P> 0.05). Conclusion: LCAF radiotherapy can improve the local control rate of advanced nasopharyngeal carcinoma without increasing the acute radiation response, LCAF can improve long-term survival rate, the need for further accumulation of cases and in-depth study.