螺旋断层放疗鼻咽癌2年经验总结

螺旋断层放疗鼻咽癌2年经验总结

杜　镭1，马　林1，冯林春1，周桂霞1，曲宝林1，任　刚1，徐寿平1，谢传滨1，张欣欣2，李　方3

解放军总医院，北京　100853　1放疗科；2耳鼻咽喉头颈外科；3肿瘤内科

摘要：目的总结解放军总医院螺旋断层放疗鼻咽癌的2年临床经验及近期结果。方法 2007年9月-2009年9月间收治73例初治鼻咽癌患者，其中单纯放疗24例，同步综合治疗49例。处方剂量：原发灶及转移淋巴结计划靶区70-74Gy/33F，高危计划靶区60-62.7Gy/33F，低危计划靶区52-56Gy/33F。根据RTOG/EORTC标准评价急性反应。结果 平均出束治疗时间为468.8s。放疗急性反应发生率：皮肤0级2.7%，1级76.7%，2级13.8%，3级6.8%；口腔黏膜0级1.4%，1级32.9%，2级60.2%，3级5.5%；口干0级4.0%，1级45.3%，2级50.7%。口干症随时间逐渐缓解，至放疗结束后1年无≥2级口干。同步化疗显著增加了急性反应。放疗结束1月时，鼻咽原发病灶及颈部转移性淋巴结消退率分别为91.8%和98.1%。中位随访时间14.8个月。2例患者放疗结束后肿瘤局部复发，2例患者出现远处转移。1年无复发生存率、无远处转移生存率及总生存率分别为95.6%、97.2%和94.8%。结论 鼻咽癌螺旋断层放疗是一种高效、安全、有效的治疗方式。关键词：鼻咽癌，断层调强放疗；急性反应，生存率

中图分类号：R 815 文献标识码：A 文章编号：1005-1139(2011)01-0048-04

Two-year experiences in treatment of nasopharyngeal carcinoma with helical tomotherapy

DU Lei1, MA Lin1, FENG Lin-chun1, ZHOU Gui-xia1, QU Bao-lin1, REN Gang1, XU Shou-ping1, XIE Chuan-bin1, ZHANG Xin-xin2, LI Fang3 1Department of Radiation Oncology; 2Department of Otolaryngology; 3Department of Medical Oncology　Chinese PLA General Hospital, Beijing 100853, China

Corresponding author: MA Lin. Email: malinpharm@

Abstract: Objective To summarize the experience in treatment of nasopharyngeal carcinoma(NPC) with helical tomotherapy in our hospital. Methods Of the 73 NPC patients admitted to our hospital from September 2007 and September 2009, 24 were treated with simple tomotherapy, 49 were treated with combined tomotherapy and medical therapy. The tomotherapy dose was 70–74Gy/33F for primary tumor and metastatic lymph node target region，60–62.7Gy/33F for high risk target region, and 52–56Gy/33F for low risk target region, respectively. Acute side-effects were evaluated following the established RTOG/EORTC criteria. Results The average beam-on time was 468.8s. The incidence rate of skin toxicity was 2.7%, 76.7%, 13.8% and 6.8%, respectively for grades 0-3. The incidence rate of oral mucositis was 1.4%, 32.9%, 60.2% and 5.5%, respectively for grades 0-3. The incidence rate of xerostomia was 4.0%, 45.3% and 50.7%, respectively for grades 0-2. Xerostomia relived gradually with time and no grade 2 or higher xerostomia was noted one year after tomotherapy. Combined tomotherapy and chemotherapy significantly increased the incidence of severe acute side effects. One month after tomotherapy, the remission rate of NPC and lymph node metastasis was 91.8% and 98.1%, respectively. The median follow-up was 14.8 months. Two patients had a local recurrence and 2 patients developed distant metastasis. The relapse-free survival, distant metastasis-free survival and one-year overall survival rates were 95.6% 97.2% and 94.8%, respectively. Conclusion As a curative treatment modality, helical tomotherapy is effective and safe for NPC.

Key words: Nasopharyngeal Cancer, Helical Tomotherapy; Acute Toxicities, Survival

鼻咽癌是我国最常见的头颈部恶性肿瘤之一，主要高发于我国东南沿海地区，但近年来由于环境污染以及人口流动等因素的影响，中国北方地区鼻咽癌的发病率呈上升趋势。由于其解剖及生物学上的特殊性，使得放射治疗或以放疗为主的综合治疗被公认为有效的根治性手段。我院于2007年9月将国内首台螺旋断层放疗(Tomo therapy，TH)系统引入临床，现将前2年内收治的73例患者近期临床观察结果报告如下。

材料和方法

1临床资料　2007年9月-2009年9月收治经组织病理学证实的鼻咽癌73例，所有患者均经过鼻咽CT或MRI、胸部CT、腹部及颈部超声、全身骨扫描(ECT)、血细胞计数及肝肾功能检测等检查，必要时行全身PET-CT检查。全组病例均按92福州分期标准进行分期(表1)，患者基本资料见表2。2治疗方案　全部患者均接受根治性螺旋断层放疗，其中24例接受单纯放疗，同步综合治疗49例。根据患者分期及各自情况，伴随放疗的同步治疗包括4种方式：1)顺铂(DDP)80mg/m2(第1天，每3周重复)；2)DDP 60mg/m2(第1天，每3周重复)+

收稿日期：2010-05-17 修回日期：2010-06-17作者简介：杜镭，男，硕士。Email: coolbile_1999@ 通信作者：马林。Email: malinpharm@