腔内后装放疗治疗鼻咽癌放疗后局部残存患者的随机对照研究

目的:观察腔内后装放疗治疗鼻咽癌根治外照射后鼻咽局部残存患者的生存率,并通过多因素分析寻找影响生存率的预后因素。方法:1999年6月至2 0 0 3年2月间,共92例根治外照射后鼻咽局部残存患者入组,随机分为两组,对照组4 1例给予观察处理,治疗组5 1例给予腔内后装放疗。腔内后装放疗于根治性外照射放疗后1周内开始,后鼻镜下置管,根据病情采用双管或单管法。治疗长度2cm ,参考距离为源外1cm1.2cm ,参考剂量5Gy/f,共2次3次,每周治疗1次2次,总量10Gy15Gy。放疗反应主要观察鼻塞,鼻腔坏死,软腭穿孔和鼻咽、鼻腔出血。结果:经过中位34个月(12个月5 6个月)的随访,总的3a生存率为6 8.2 4 % ,中位生存时间4 4个月。单因素分析显示治疗组与对照组之间,同步化疗与未同步化疗患者之间,T1、T2 期与T3 期患者之间生存率差异有显著性。相应的3a生存率、中位生存期及P值分别76 .4 4 % ,5 2个月和5 8.4 3% ,4 2个月(P =0 .0 397) ;75 .81% ,5 2个月和6 1.95 % ,4 0个月(P =0 .0 35 ) ;73.6 % ,4 8个月和5 5 .17% ,39个月(P =0 .0 4 92 )。多因素分析显示是否行腔内后装放疗和是否同步化疗是影响生存率的独立预后因素。放疗反应治疗组所有患者均有鼻塞反应,并观察到软腭穿孔,鼻腔坏死各1例。结论:腔内后装放疗治疗鼻咽癌放?

A Random Study of Intracavitary Brachtherapy in Treatment of Patients With Locally Persistent Nasopharyngeal Carcinoma After Radical Conventional External Radio therapy

Objective To evaluate the effect of intracavitary brachytherapy for patients with locally persistent nasopharyngeal carcinoma after radical conventional external radiotherapy,and explore the prognostic factors for survival rate by multivariable analysis.Methods and Materials From Jun 1999 through Feb 2003,92 patients with locally persistent nasopharyngeal carcinoma after radical conventional external radiotherapy were randomized into two groups:41 cases in compare group were observed and 51 cases in treatment group received intracavitary brachytherapy. Intracavitary brachytherapy was begined in one week after radical conventional external radiotherapy.Applicator were placed at the surveillance of posterior rhinoscope. According to the states of patients,single or duplex-channel nasal applicators were used.Dose was prescribed at 1 cm~1.2 cm from source,and total dose of 10 Gy~15 Gy in 2~3 fractions with 1~2 fractions per week was given. Therapeutic length for all patients were 2 cm.To evaluate the toxicity, nasal obstruction, nasal cavit necrosis, soft palate perforation, nasopharynx and nasal cavit bleed were observed.Results With a median follow up of 34 monthes(rang from 12~56 monthes),the overall survival rate at 3-year was 68.24 %,the median survival time was 44 monthes. Using singlevariable analysis, the survival rate difference between treatment group and compare group;patients with concomitant chemotherapy and non chemotherapy;stage T 1,T 2 and T 3 have statistical significance.The correspondent 3 year survival rate ,median survival time was 76.44 %,52 monthes and 58.43 %, 42 monthes(P=0.0397);75.81 %,52 monthes and 61.95 %,40 monthes (P=0.035);73.6 %,48 monthes and 55.17 %,39 monthes (P=0.049 2) respectively.Using multivariable analysis,brachytherapy and concomitant chemotherapy were independent prognostic factor effecting survival rate.For radiation toxicity, all patients in treatment group have nasal obstruction,and one case with soft palate perforation,one case with nasal cavit necrosis were observed.Conclusion Intracavitary brachytherapy in treatment of patients with locally persistent nasopharyngeal carcinoma after radical conventional external radiotherapy can increase survival rate, therapeutic alliance of conventional external radiotherapy and concomitant chemotherapy and intracavitary brachytherapy may a more effective synthetic treatment patterns.