鼻咽癌外照射加腔内近距离超分割推量照射的远期疗效分析

背景与目的:鼻咽癌的后装治疗一般采用鼻咽腔内治疗的方法进行推量照射,适用于局部早期鼻咽癌.福建省肿瘤医院率先开展鼻咽旁插植技术,无颅底破坏的局部晚期鼻咽癌采用后装治疗推量照射.本文分析腔内后装推量照射的远期疗效,探讨常规外照射的合适剂量配合后程超分割后装推量照射的临床价值.方法:1998年1月～2002年12月体外照射加腔内后装超分割推量放射治疗鼻咽癌患者352例,体外常规放射治疗50～70 Gy后进行腔内近距离超分割推量照射,外照射后咽旁间隙肿瘤残留者配合咽旁区插植放疗.采用个体化鼻咽腔内施源器,超分割照射每次2.5～3.0 Gy,2次/天,间隔6 h,总剂量5～32 Gy,中位剂量17 Gy.结果:本组l、2、3、5年生存率分别为97.0%、91.3%、87.6%、84.7%.总体5年生存率Ⅰ、Ⅱ期88.2%,Ⅲ、Ⅳ期79.2%(log-rank检验,P=0.016);总体局控率Ⅰ、Ⅱ期94.1%,Ⅲ、Ⅳ期91.7%(log-rank检验,P＞0.05).后组颅神经损伤32例(9.4%).结论:鼻咽腔内后装联合咽旁间隙捅植近距离放射治疗鼻咽癌取得良好的局控率和生存率,局部晚期鼻咽癌取得与早期鼻咽癌类似的局控率,咽旁间隙受累者咽旁插植增加颈动脉鞘区照射剂量,后组颅神经损伤发生率较高.     

The role of brachytherapy in early-stage nasopharyngeal carcinoma

To present the treatment results and assess the optimal radiation dose and the role of brachytherapy in early stage nasopharyngeal cancer (NPC).

One hundred eighty-three patients with Stage I and II (American Joint Committee on Cancer Staging System, 1987) NPC completed the planned radiotherapy in our institution from 1979 to 1991. In 133 patients, radiotherapy was given to the nasopharynx by external beam to 64.8–68.4 Gy. Further boost was done by high dose rate (HDR) brachytherapy for 5–16.5 Gy in one to three fractions. For the remaining 50 patients, a course of external radiotherapy to the nasopharynx for 68.4–72 Gy was given to nasopharynx. Age (>40 or not) sex, neck boost or not, brachytherapy, and irradiation dose were analyzed to determine significant factors that influence the probabilities of local control and actuarial survival.

The 5-year disease-specific survival was 85.8% and local control was 83%. Only the brachytherapy and irradiation dose significantly affected the results. The use of the brachytherapy had significant impact on overall survival and local control. Furthermore, we compared the prognostic effect of various radiation dosage among Group I of 50 patients (<72.5 Gy, no brachytherapy, excluding four patients who received brachytherapy), Group II of 71 patients (72.5–75 Gy; one to two fractions of brachytherapy), and Group III of 58 patients (>75 Gy; three fractions of brachytherapy). Five-year disease-specific survival rates of Group I, Group II, and Group III were 77, 95.5, and 82.4%, respectively. Five-year local control rates were: 73.7, 93.9, and 79.5%. We found that the Group II had the best actuarial survival and local control rate (log-rank test, p < 0.05). Most patients receiving brachytherapy encountered foul odor because of nasopharynx crust; 12 of them had palate or sphenoid sinus floor perforation or nasopharynx necrosis. None of the patients without brachytherapy experienced the same complications.

The optimal radiotherapy dose to the nasopharnyx area in early stage NPC may be within 72.5 to 75 Gy by our treatment protocol. A dose of more than 75 Gy did not have significant local control or survival advantage. The use of brachytherapy to elevate radiation dose had significant local control and survival benefit for early stage NPC patients, but the fractionation size should be decreased to reduce the complications.     

Analysis of 80 Cases of Nasopharyngeal Carcinoma Treated by Intracavitary Brachytherapy Using A New- Type Applicator

OBJECTIVE To evaluate the results and complications associated with nasopharyngeal carcinoma （NPC） treated with combined external-beam radiotherapy （EBR） and intracavitary brachytherapy （IB） using a new-type applicator. METHODS Eighty patients with untreated NPC were divided into two groups based on therapy methods. An experimental group was treated with EBR plus IB and a control group was treated only with EBR. IB was given to the patients of the experimental group when the external radiotherapy dose amounted to more than 60～65 Gy. The total dose of IB was 6～20 Gy and the total dose of EBR of the control group was 70～75 Gy. RESULTS Follow-up was conducted for 97.5% of the patients with re- suits as follows： the overall response rates （ORR） for the experimental and the control groups were 92.5% and 75.3% respectively （P〈0.05）; the 3 and 5-year survival rates for the experimental group were 87.5% and 74.2% and for the control group, 65.0% and 55.6% （P〈0.05）; for the experimental group, the 3 and 5-year disease-free survival rates were 72.5% and 64.5% and for the control group, 60.0% and 52.8% （P〉0.05）.Some complications following radiotherapy showed a significant difference. CONCLUSION External irradiation plus intracavitary brachytherapy using a new-type applicator may improve the ORR and survival rates, reduce radiation complications and increase the quality of life.     

1837例鼻咽癌疗效的回顾性分析

目的 总结我院鼻咽癌常规放疗的疗效和经验.方法 回顾性分析2000年1月至2003年12月收治的1837例经病理证实的初治鼻咽癌患者.年龄8～87岁(48岁),男1403例,女434例,男:女=3.2:1.1992年福州分期T1、T2、T3、T3期分别为364、995、274、204例,N0、N1、N2、N3期分别为412、801、514、110例.Ⅰ、Ⅱ、Ⅲ、ⅣA、ⅣB期分别为77、777、668、291、24例.959例局部晚期患者中,单纯放疗363例,综合治疗596例.855例接受以顺铂为基础化疗.鼻咽原发病灶主要采用60Coγ线、6MV X线常规分割照射,1.8～2.0 Gy/次,总剂量30.6～74.0 Gy.常规放疗结束后如鼻咽镜或CT提示有肿瘤残存者,则通过耳后野、颅底野、后装及适形加量6～20 Gy.颈部放射源用60Coγ线、180 kV X线和9 MeV电子束,N0期患者仅照射上颈部,有颈部转移者照射全颈.预防总剂量50～56 Gy,根治总剂量60～68 Gy.结果 中位随访54个月,5年总生存率、无瘤生存率、无复发生存率、无远处转移生存率分别为67.42%、63.25%、86.47%和80.31%.Ⅰ、Ⅱ、Ⅲ、ⅣA、ⅣB期的5年生存率分别为88%、74.8%、65.9%、52.4%、20%.Ⅲ+ⅣA期959例中单纯放疗、综合治疗的5年生存率分别为63.7%和60.7%(P=0.216).Ⅲ期668例中单纯放疗(279例)和综合治疗(389例)的5年生存率分别为65.2%和66.5%(P=0.810).单因素分析显示与总的牛存有关的因素有性别、T分期、N分期、M分期、92福州分期、贫血、治疗前LDH水平、化疗、后装治疗及面颈联合野.多因素Cox回归分析显示性别、T分期、N分期、92福州分期与总生存有关.结论 鼻咽癌常规治疗5年生存率达67.4%,总生存与性别、T分期、N分期、M分期、福州分期、贫血等有关.     

复发性鼻咽癌三维适形放射治疗的疗效分析

目的 分析复发性鼻咽癌三维适形放射治疗的疗效及影响疗效的因素.方法 56例复发性鼻咽癌接受三维适形放射治疗,鼻咽部剂量50～70Gy/36～52d(中位64Gy/44d).结果 全组病例随访3年以上.3年总生存率、无瘤生存率和鼻咽部局部控制率分别为48.2 %、44.6%和53.6%.复发间隔时间＞2年和复发临床分期T2期者,3年生存率和局部控制率高(P＜0.05);再程放疗剂量≥60Gy者,3年生存率和局部控制率优于＜60Gy.结论 三维适形放射治疗是复发性鼻咽癌有效的治疗手段,其复发间隔时间、复发临床分期和再程放疗剂量是影响预后的因素.     

High-dose-rate intracavitary brachytherapy boost for early T stage nasopharyngeal carcinoma{private}

PURPOSE: To investigate any possible therapeutic gain from dose escalation with brachytherapy for early T stage nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: One hundred forty-five patients with T1-2b N0-3 NPC were boosted with high-dose-rate intracavitary brachytherapy after completion of two-dimensional external radiotherapy (ERT) during the period from 1999 to 2003. To compare the efficacy of brachytherapy boost, another 142 patients with T1-2b N0-3 disease who were treated with ERT alone during 1994 to 1999 were evaluated. All patients were treated with ERT to a total dose of 66 Gy in 6.5 weeks. The brachytherapy boost group was given 10-12 Gy in 2 weekly fractions. RESULTS: Dose escalation beyond 66 Gy with brachytherapy boost was shown to improve local control and survival. The 5-year actuarial local failure-free survival, regional failure-free survival, distant metastasis-free survival, progression-free survival, cancer-specific survival, and overall survival rates for the brachytherapy group and the control group were 95.8% and 88.3% (p = 0.020), 96% and 94.6% (p = 0.40), 95% and 83.2% (p = 0.0045), 89.2% and 74.8% (p = 0.0021), 94.5% and 83.4% (p = 0.0058), and 91.1% and 79.6% (p = 0.0062), respectively. The 5-year major-complication-free survival rate was 89.5% for the brachytherapy group and 85.6% for the control group (p = 0.23). CONCLUSIONS: For patients who are treated with two-dimensional treatment techniques, dose escalation with brachytherapy boost improves local control and overall survival of patients with T1-T2a and possibly non-bulky T2b disease.     

Ⅰ、Ⅱ期鼻咽癌外照射加腔内放疗远期疗效的前瞻性研究

背景与目的:近距离放疗的空间剂量分布和外照射明显不同,两者联合使用可以优势互补,提高剂量分布的适形度.本研究旨在探讨Ⅰ、Ⅱ期鼻咽癌患者采用单纯外照射放疗与外照射加腔内联合放疗的长期疗效差异.方法:将321例Ⅰ、Ⅱ期鼻咽癌患者,随机分为单纯外照射组223例,外照射加腔内联合放疗组98例;单纯外照射组采用低熔点铅挡块不规则野照射,常规方法照射,常规分割,总剂量为66～74 Gy;联合放疗组采用同样的外照射方法,总剂量给与58～62 Gy,接着给予15～20 Gy腔内近距离放疗.结果:经过5年的随访,单纯外照射组鼻咽复发16例,死亡35例,Ⅰ、Ⅱ期鼻咽癌患者的5年生存率分别为90.63%和80.82%(P=O.018);联合照射组鼻咽复发1例,死亡6例,Ⅰ、Ⅱ期鼻咽癌的5年生存率分别为95.24%和93.36%(P=0.025).口干和张口困难的不良反应以联合照射组较轻.结论:Ⅰ、Ⅱ期鼻咽癌患者采用外照射加腔内放疗相对单纯外照射有较好的疗效并可减轻不良反应.     

不同照射方式下非常规分割方案的生物效应对鼻咽癌疗效的影响

[目的]探讨不同照射方式（调强和普放）中采用非标准分割方案的疗程总剂量及分次剂量、总时间及分次数对鼻咽癌疗效的影响。[方法]回顾性分析2004年1～12月经病理确认并进行放射治疗且随访到2009年12月的资料完整的Ⅱ～Ⅳ期鼻咽癌病例162例,调强组57例,普放组105例;调强组和普放组给予肿瘤的总平均物理剂量分别为72Gy和76Gy,所对应的生物等效剂量（EQD2T）分别是75.5Gy和70Gy。调强组采用鼻咽加上下颈淋巴引流区同期加速推量动态调强放疗技术,普放组采用面颈联合野加颈部切线野常规放疗技术。[结果]调强组和普放组5年生存率分别为71.9%和70.5%,5年局控率分别为84.2%和78.1%,5年无瘤生存率分别为73.7%和71.4%,均无显著性差异。5年并发症发生率调强组低于普放组（65.9%vs85.1%,P=0.016）。[结论]调强和普放照射方式中采用72～76Gy物理剂量所反映的生物效应对鼻咽癌疗效影响不明显,两组的生存率和局控率接近。调强技术降低放疗损伤与晚反应组织生物剂量无关,但和物理优化技术有关。     

Nasopharyngeal carcinoma treated with external radiotherapy, brachytherapy, and concurrent/adjuvant chemotherapy

The standard treatment for advanced nasopharyngeal carcinoma (NPC) has become external beam radiation therapy (EBXRT) 70 Gy/7 weeks + 3 cycles of concurrent cisplatin followed by 2 to 3 cycles of adjuvant cisplatin/5-fluorouracil (5-FU). Some reports suggest that the addition of low-dose rate brachytherapy to EBXRT also improves local control. To our knowledge, this is the first report of the "triple" combination of EBXRT, brachytherapy, and concurrent/adjuvant chemotherapy. Eleven patients treated from 1992 to 1998 were evaluated. All patients had stage III/IV (excluding T4 lesions) NPC. Treatment consisted of EBXRT (64-70 Gy/7 weeks), followed by a brachytherapy boost (6-15 Gy delivered 0.5 cm deep to the mucosa). Chemotherapy consisted of concurrent cisplatin (100 mg/m2) and post-XRT adjuvant cisplatin (80 mg/m2) and 5-FU (1,000 mg/m2/day x 4 days) for 2 cycles. All 11 patients were evaluable. The average age was 44 years, and median follow-up was 38 months (range: 23-82 months). Median EBXRT dose was 66 Gy, and median brachytherapy dose was 9 Gy (median total dose: 75 Gy). All patients obtained primary tumor complete response (CR). Two patients required post-XRT neck dissection to achieve regional CR. To date, 10 patients are alive with no evidence of disease. The 3-year actuarial survival is 100%. One patient died at 82 months of a late distant recurrence (at 37 months post-XRT). No patient has had a local or neck failure. Chemoradiation plus brachytherapy offers encouraging survival and local-regional control. Further study of this regimen as an alternative or adjunct to intensity-modulated EBXRT is warranted.     

鼻咽癌放射治疗10年疗效分析 (附160例报告)

目的：通过长期随访分析讨论鼻咽癌放射治疗１０年疗效及影响因素。方法：对随访１０年以上１６０例鼻咽癌患者的性别、年龄、病理类型、分期、分型,原发灶及颈部放射剂量进行统计及χ＾２检验。结果：放射治疗后１０年生存率为２１．９％,其疗效与临床分期、分型及原发灶放射剂量关系密切（Ｐ〈０．０５）,失败原因为远处转移及局部复发。结论：分期早及上行型生存率高,原发灶放射剂量以７０～８０Ｇｙ较好。     

Intracavitary brachytherapy significantly enhances local control of early T-stage nasopharyngeal carcinoma: the existence of a dose-tumor-control relationship above conventional tumoricidal dose

PURPOSE: To study the efficacy of intracavitary brachytherapy (ICT) in early T-stage nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: All T1 and T2 (nasal infiltration) NPC treated with a curative intent from 1984 to 1996 were analyzed (n = 509). One hundred sixty-three patients were given ICT after radical external radiotherapy (ERT) (Group A). They were compared with 346 patients treated by ERT alone (Group B). The ERT delivered the tumoricidal dose (uncorrected BED-10 > or =75 Gy) to the primary tumor and did not differ between the two groups in technique or dosage. The ICT delivered a dose of 18-24 Gy in 3 fractions over 15 days to a point 1 cm perpendicular to the midpoint of the plane of the sources. ICT was used to treat local persistence diagnosed at 4-6 weeks after ERT (n = 101) or as an adjuvant for the complete responders to ERT (n = 62). RESULTS: The two groups did not differ in patients' age or sex, rate of distant metastasis, rate of regional failure, overall survival, or the follow-up duration. However, Group A had significantly more T2 lesions and Group B had significantly more advanced N-stages. Local failure was significantly less (crude rates 6.75% vs. 13.0%; 5-year actuarial rates 5.40% vs. 10.3%) and the disease-specific mortality was significantly lower (crude rates 14.1% vs. 21.7%; 5-year actuarial rates 11.9% vs. 16.4%) in Group A compared to Group B. Multivariate analysis showed that the ICT was the only significant prognostic factor predictive for fewer local failures (Cox regression p = 0.0328, risk ratio = 0.49, 95% confidence interval (95% CI) = 0.256-0.957). However, when ICT was excluded from the Cox regression model, the total physical dose or the total BED-10 uncorrected for tumor repopulation during the period of radiotherapy became significant in predicting ultimate local failure rate. The two groups were comparable in the incidence rates of each individual chronic radiation complication and the actuarial cumulative rate of the chronic radiation complications, with the exception of chronic radiation nasopharyngeal ulceration/necrosis which occurred in 10 patients in Group A and 1 patient in Group B. Headache (n = 4) and foul smell (n = 8) consequential to ulceration/necrosis were mild and manageable by conservative means. A significant dose-tumor-control relationship existed when local failure was studied as a function of the total physical dose or the total biological equivalent dose (linear quadratic equation, alpha/beta = 10) uncorrected for tumor repopulation during the time course of the radiotherapy. CONCLUSIONS: Supplementing ERT which delivered tumoricidal dose (uncorrected BED-10 > or =75 Gy), ICT significantly enhanced ultimate local control and avoided the necessity for morbid salvage treatments in early T-stage (T1/T2 nasal infiltration) NPC. The slight increase in chronic radiation ulceration/necrosis after ICT was acceptable with mild and manageable symptoms. Other late complications were not increased. A significant dose-tumor-control relationship exists above the conventional tumoricidal dose level.     

鼻咽癌面颈联合野配合后程超分割放疗疗效分析

目的 观察后程超分割治疗鼻咽癌的疗效及毒副反应。方法 93例鼻咽癌患者被随机分为后程超分割治疗组（后超组47例）和常规分割对照组（常规组46例）。均先行面颈联合野常规分割对穿照射Dr36Gy，20分次，4周，后超组缩野改用后程超分割照射，1．15～1．20Cy／次，2次／d，两次间隔时间6，8h，5d／周，鼻咽病灶总Dr74．8～76．7Gy，54分次，7．5周完成。对照组缩野后常规照射2．0Gy／次，1次／d，鼻咽灶总D169～72Gy，37～38分次，7．5周完成。颈部均为常规照射。结果 后超组和常规组鼻咽部肿瘤消退率分别为100％、96％（X^2=2．10，P〉0．05）；1、3、5年肿瘤局部控制率分别为100％、98％、86％和100％、86％、54％（X^2=10．90，P〈0．01）；1、3、5年生存率分别为100％、94％、85％和98％、84％、63％（X^2=8．70，P〈0．01）。两组放疗口腔黏膜反应无差别（X^2=1．00，P=0．800）。后超组复发率低于常规组（11％：30％；X^2=5．60，P〈0．05），而转移率无差别（12．8％：28．3％；X^2=3．40，P〉0．05）。结论 鼻咽癌后程超分割的局部控制率及长期生存率明显高于常规组，而急性毒性反应及复发转移无明显差别。     

Therapeutic results of alternating chemoradiotherapy for nasopharyngeal cancer using cisplatin and 5-fluorouracil: its usefulness and controversial points

BACKGROUND: The present study was conducted to evaluate the therapeutic results of alternating chemoradiotherapy for locally advanced nasopharyngeal cancer (NPC). METHODS: The subjects consisted of six patients with stage III nasopharyngeal cancer and 26 patients with stage IV nasopharyngeal cancer. Using 6 MV photons, radiotherapy was performed at an exposure of 1.8-2.0 Gy five times per week. That is, a total absorbed dose of 36-40 Gy was irradiated between the base of the skull and supraclavicular fossa. After decreasing the irradiation field, an absorbed dose of 26-30 Gy was additionally given thereafter. One course of chemotherapy consisted of the administration of 5-fluorouracil (5-FU) at a dose of 700 mg/m2/24 h for 5 days (days 1-5) and cisplatin (CDDP) at a dose of 50 mg/m2/24 h for 2 days (days 6-7) and a total of 2-3 courses of chemotherapy were performed. During the alternating chemoradiotherapy, chemotherapy was performed initially and 3-5 days after completing the chemotherapy, radiotherapy was performed for 3-4 weeks. Thereafter, chemotherapy and radiotherapy were performed alternately. RESULTS: The scheduled courses of alternating chemoradiotherapy were completed in 30 (94%) of 32 patients. Although one patient developed shock induced by metal allergy to CDDP, no severe adverse effects were noted in any other patients. In these 32 patients, the overall 5-year survival rate was 75% (95% confidence interval: 60-90%) and the progression-free survival rate was 63% (95% CI: 46-89%). CONCLUSIONS: This method of alternating chemoradiotherapy yielded higher or at least similar survival rates and lower toxicities than concurrent chemoradiotherapy and is worth trying in a multi-institutional study.     

High-dose, high-precision treatment options for boosting cancer of the nasopharynx.

PURPOSE: The aim of the study is to define the role and type of high-dose, high-precision radiation therapy for boosting early staged T1,2a, but in particular locally advanced, T2b-4, nasopharyngeal cancer (NPC). MATERIALS AND METHODS: Ninety-one patients with primary stage I-IVB NPC, were treated between 1991 and 2000 with 60-70Gy external beam radiation therapy (ERT) followed by 11-18Gy endocavitary brachytherapy (ECBT) boost. In 1996, for stage III-IVB disease, cisplatinum (CDDP)-based neoadjuvant chemotherapy (CHT) was introduced per protocol. Patients were analyzed for local control and overall survival. For a subset of 18 patients, a magnetic resonance imaging (MRI) scan at 46Gy was obtained. After matching with pre-treatment computed tomogram, patients (response) were graded into four categories; i.e. LD (T1,2a, with limited disease, i.e. disease confined to nasopharynx), LRD (T2b, with limited residual disease), ERD (T2b, with extensive residual disease), or patients initially diagnosed with T3,4 tumors. Dose distributions for ECBT (Plato-BPS v. 13.3, Nucletron) were compared to parallel-opposed three-dimensional conformal radiation therapy (Cadplan, Varian Dosetek v. 3.1), intensity modulated radiation therapy (IMRT) (Helios, Varian) and stereotactic radiotherapy (SRT) (X-plan, Radionics v. 2.02). RESULTS: For stage T1,2N0,1 tumors, at 2 years local control of 96% and overall survival of 80% were observed. For the poorest subset of patients, well/moderate/poorly differentiated T3,4 tumors, local control and overall survival at 2 years with CHT were 67 and 67%, respectively, vs. local control of 20% and overall survival of 12% without CHT. For LD and LRD, conformal target coverage and optimal sparing can be obtained with brachytherapy. For T2b-ERD and T3,4 tumors, these planning goals are better achieved with SRT and/or IMRT. CONCLUSIONS: The dosimetric findings, ease of application of the brachytherapy procedure, and the clinical results in early staged NPC, necessitates ERT combined with brachytherapy boost to be the therapy of preference for LD and LRD. For locally advanced T3,4 tumors, our current protocol indicates neoadjuvant chemotherapy in conjunction with high cumulative doses of radiotherapy (81Gy); IMRT and/or SRT to be the preferred technique for boosting the primary tumor.     

Improved local control for early T-stage nasopharyngeal carcinoma--a tale of two hospitals.

PURPOSE: To study the efficacy of intracavitary brachytherapy (ICT) in early T-stage nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: All early T-stage (T1 and T2 nasal cavity tumour) NPC treated with a curative intent up to 1996 were analyzed (n=743), 163 from the Prince of Wales Hospital (PWH) and 25 from Tuen Mun Hospital (TMH) were given ICT after radical external radiotherapy (ERT; group A). They were compared with 555 patients treated with ERT alone (group B). The radiotherapy techniques were identical between the two hospitals. The ERT delivered the tumoricidal dose (uncorrected biological equivalent dose (BED)-10, > or = 75 Gy) to the primary tumour, and this did not differ in technique or dosage between the two groups. The ICT delivered a dose of 18-24 Gy in three fractions over 15 days to a point 1 cm perpendicular to the midpoint of the plane of the sources. RESULTS: The local failure was significantly less (crude rates, 6.9 vs. 13.0%; 5-year actuarial rates, 5.8 vs. 11.7%) and the disease-specific mortality was significantly lower (crude rates, 13.8 vs. 18.9%; 5-year actuarial rates, 12.2 vs. 15.2%) in group A compared with group B. ICT was the only significant independent prognostic factor predictive of fewer local failures. When ICT was excluded from the Cox regression model, the total physical dose or the total BED-10 uncorrected for tumour repopulation became significant in predicting the ultimate local failure rate. The two groups were comparable in the rate of the chronic radiation complications. A significant dose-tumour-control relationship existed, plotting the local failure as a function of the total physical dose or the total BED. CONCLUSIONS: Supplementing ERT, which delivered the tumoricidal dose (uncorrected BED-10, > or = 75 Gy), with ICT significantly enhanced ultimate local control in early T-stage (T1/T2 nasal infiltration) NPC. A significant dose-tumour-control relationship exists above the conventional tumoricidal dose level.     

Nasopharyngeal carcinoma treated by radical radiotherapy alone: Ten-year experience of a single institution

PURPOSE: To report on our experience in the treatment of nasopharyngeal carcinoma (NPC) by radical radiotherapy alone in our institution during the last decade. METHODS AND MATERIALS: From January 1990 to May 1999, 905 NPC patients were treated and were studied retrospectively. Radical radiotherapy was given to this cohort by conventional technique in a routine dose of 70-72 Gy to the primary tumor and metastatic lymph nodes. In case of residual primary lesion, a boost dose of 8-24 Gy was delivered by either 192Ir afterloading brachytherapy, fractionated stereotactic radiotherapy, conformal radiotherapy, or small external-beam fields. RESULTS: The 5-year and 10-year local-regional control, overall survival, and disease-free survival rates were 81.7% and 76.7%, 76.1% and 66.5%, 58.4% and 52.1%, respectively. In case of residual primary lesions after a dose of 70-72 Gy of conventional external-beam radiotherapy (EBRT), an additional boost was able to achieve a local control of 80.8%, similar to that obtained with primary lesions that completely disappeared at 70-72 Gy (82.6%, p = 0.892). CONCLUSIONS: The treatment results of radical EBRT followed by a boost dose to the residual primary tumor for nasopharyngeal carcinoma in our institution are promising.     

不同放射治疗方式致鼻咽癌患者腮腺功能损伤的研究

目的评价不同放射治疗方式对鼻咽癌患者腮腺功能的损伤状况。方法常规分割（CF）组175例,总量70Gy;后程加速超分割放射治疗（LCAF）组63例,先用CF照射36—40Gy,再用LCAF照射35～40Gy,总量75Gy;调强适形放射治疗（IMRT）组142例,处方剂量72Gy。放射治疗期间观察急性放射性腮腺炎发生情况,2年后测定腮腺静止性分泌功能。结果IMRT组的腮腺受照射剂量远远低于其他两组。CF组、LCAF组和IMRT组急性放射性腮腺炎发生率分别为23．4％、41．3％和20．4％,差异有统计学意义（P〈0．05）。2年后,CF组、LCAF组和IMRT组腮腺分泌功能下降率分别为81．7％、81．0％和69．7％,差异有统计学意义（P〈0．05）。结论不同放射治疗方式对鼻咽癌患者的腮腺功能损伤程度不同,IMRT有利于覆盖肿瘤靶区,并使邻近敏感器官获得有效分割,使腮腺功能得到较好保护。     

非根治剂量的体外照射配合腔内放疗加根治术治疗宫颈癌

目的 总结分析外照射配合腔内放疗加根治术治疗Ⅰb-Ⅲa期宫期癌的5年生存率和晚期并发症。方法 106例宫颈癌均行广泛性子宫切除和盆腔淋巴结清除术,其中78例行术前放疗（体外加腔内放疗,下同）,16例采用腔内放疗＋手术,12例术后放疗。外照射采用^60Co治疗机,给予合盆或盆腔四野照射,B点剂量术前放疗者为25－30Gy,术后放疗者为40－50Gy;腔内放疗采用^192Ir高剂量率后装机,A点剂量6－18Gy。结果 （1）5年生存率：Ⅰb-Ⅲa期术前放疗组为78.2%（61／78）,腔内＋手术组为68.8%（11／16）,术后放疗组为33.3%（4／12）。术前放疗组与术后放疗组相比,差异有显著性（P＜0.05）。术前放疗组中,Ⅱ期患者的5年生存率(77.6%,45／58）高于术后放疗组（1／4,P＜0.05）。（2）主要并发症：多为放射性直肠炎和膀胱炎。术前放疗组、腔内放疗＋手术组和术后放疗组的并发症发生率分别为34.6%(27/78）、31.3%（5／16）和33.3%(4/12),差异无显著性（P＞0.05）。结论 非根治量的体外照射配合腔内放疗加根治术治疗宫颈癌,可提高Ⅰb-Ⅲa期患者总的5年生存率和Ⅱ期患者的5年生存率,晚期并发症发生率差异无显著性。     

儿童鼻咽癌放射治疗的远期疗效

背景与目的:儿童鼻咽癌是一种特殊类型的鼻咽癌,治疗效果较差。本文分析儿童鼻咽癌的远期疗效,并探讨影响其疗效的有关因素,为制定合理的诊疗措施提供依据。方法:从1975年1月至1995年12月,共有47例经病理组织学确诊、7～14岁的儿童鼻咽癌患者在我院接受放射治疗,鼻咽剂量为6～13周52～74Gy,平均为(64.68±5.68)Gy;颈部剂量为5～13周46～73Gy,平均(57.77±5.86)Gy。21例在放疗前接受化疗,其中13例接受以DDP为基础的方案化疗1～3个疗程。用SPSS10.0统计软件包的Kaplan-Meier法计算生存率,用log-rank法对单纯放疗组及化放疗组患者的生存率进行比较。结果:全组1、3、5年生存率分别为72.3%、53.2%和40.4%。影响儿童鼻咽癌远期疗效的因素有临床分期(P=0.0463)、活检方式(P=0.0236)、鼻咽照射剂量(P=0.0494)和近期疗效(P=0.0050)。生存5年以上的15例男性患者平均身高(161.5±1.2)cm,其中身高等于或低于160cm7例,占46.7%,最矮者只有150cm。3例女性患者中,月经正常1例,月经紊乱2例。结论:临床分期、活检方式、鼻咽照射剂量和近期疗效是影响儿童鼻咽癌放射治疗远期疗效的因素,儿童鼻咽癌放射治疗的远期后遗症不容忽视。     

两种非常规分割放疗治疗鼻咽癌的疗效分析

目的 对比观察两种放疗方式治疗鼻咽癌的局部控制率及急性反应和晚期损伤。方法 60例NO-2患者随机分为两组,一组采用标准超分割(HFR)方式放疗,总量DT 76.8 Gy;另一组采用前后程加速超分割(AHFR)方式放疗,总量DT72～75 Gy。结果 (1)两组的5年总生存率和5年无病生存率分别为69.84％、65.86％和62.86％、55.35％。两组的局部控制率均为93.33％。(2)AHFR组与HFR组的急性黏膜反应程度相似,AHRF组略高于HFR组。晚期反应两组无明显差异。(3)放疗结束时局部肿瘤的近期消退率AHFR组低于HFR组。半年时两者CT消退率相同。结论 两种放疗方式无明显差异,标准超分割放疗方式更简便易行。