目的 分析鼻咽癌后程加速超分割放射治疗后局部和远处失败的因素。方法对无远地转移的178例初治鼻咽低分化鳞癌行后程加速超分割放射治疗。原发灶采用~(60)Co γ射线或6MV X射线,前4周1.2Gy/次,2次/d,间隔≥6h,5d/周,48Gy后改为1.5Gy/次,2次/d,5d/周,共2周。全程总剂量为78Gy,60分次,6周,其中疗程超过47d的病例均增加1d的照射量(1.2Gy/次或1.5 Gy/次,2次/d)。颈部无淋巴结转移者做预防照射,有淋巴结转移者给予根治量照射,均为常规分割放射治疗。结果 全组5年总生存率及无瘤生存率分别为72.4％和60.6％,5年鼻咽部及颈部控制率分别为88.9％和83.7％。5年远地转移率25.1％。5年内67例患者失败,其中单纯鼻咽部失败10例,颈部失败13例,远地转移31例,≥2项失败13例。单因素及多因素分析显示T3～T4期、年龄>50岁和颈动脉鞘区肿瘤完全占据是局部控制的不利预后因素。在单因素分析中有淋巴结转移是影响颈部控制率的不利因素,但多因素分析差异未达统计学意义(P>0.05)。在影响远地转移的因素中,局部晚期T3～T4期或N2～N3期,男性不论在单因素还是多因素分析均显示有统计学意义。有上述不良预后因素的患者,远地转移明显增加。结论 后程加速超分割放射治疗可以提高鼻咽癌患者的5年局部控制率和生存率。T3～T4期和(或)N2 Objective To analyze the factors of local and remote failure of nasopharyngeal carcinoma after accelerated hyperfraction radiotherapy. Methods A total of 178 untreated nasopharyngeal poorly differentiated squamous cell carcinoma patients underwent late-course accelerated hyperfractionation radiotherapy. The primary tumor was irradiated with ~ (60) Co γ-ray or 6 MV X-ray, the first 4 weeks 1.2 Gy / time, twice / d, the interval 6 hours, 5 days / week, , 5d / week, a total of 2 weeks. The total dose of 78Gy, 60 times, 6 weeks, of which more than 47d course of treatment were increased 1d exposure (1.2Gy / times or 1.5 Gy / times, 2 times / d). The neck without lymph node metastasis to prevent radiation, lymph node metastasis were given Radiation dose, are conventional radiotherapy. Results The overall 5-year overall survival rate and tumor-free survival rate were 72.4% and 60.6% respectively. The control rates of nasopharynx and neck at 5 years were 88.9% and 83.7% respectively. 5 years far transfer rate of 25.1%. Sixty-seven patients failed within 5 years, including 10 cases of simple nasopharyngeal failure, 13 cases of neck failure, 31 cases of distant metastasis, and 13 cases of ≥2 failures. Univariate and multivariate analysis showed that T3 ~ T4 stage, age> 50 years old and complete occupation of carotid sheath tumor were the unfavorable prognostic factors of local control. In univariate analysis, lymph node metastasis was the adverse factor affecting the rate of cervical control, but the multivariate analysis showed no significant difference (P> 0.05). Among the factors influencing the distant metastasis, men in the late stage of T3 ~ T4 or N2 ~ N3 showed statistical significance both in single factor and in multivariate analysis. In patients with these poor prognostic factors, distant metastases were significantly increased. Conclusions Late-course accelerated hyperfractionation radiation therapy can improve the 5-year local control rate and survival rate of patients with nasopharyngeal carcinoma. T3 ~ T4 and / or N2