119例鼻咽癌调强放疗的远期疗效分析

目的：探讨初治鼻咽癌调强放疗远期疗效及其影响因素。方法收集2005年5月～2011年12月收治的、经病理确诊的完成调强放射治疗的初治鼻咽癌患者119例，其中52例患者行单纯放疗，67例联合铂类药物为基础的化疗2～6周期。靶区剂量分别为：鼻咽原发灶66～73Gy，颈部淋巴结66～68Gy；高危区60～66Gy，预防区54～59Gy，分30～33次完成，用Kaplan-Meier法测定区域控制率、总生存率、无瘤生存率、无远处转移生存率。结果中位随访时间为30．1个月（1．6～85．3个月），失访率9．24％；远处转移病例占治疗失败病例的84．6％，死亡病例的63．9％；全组中9例和33例患者出现局部、区域复发和远处转移。3年局部区域控制率、无远处转移生存率、无瘤生存率及总生存率分别为90．2％，69．6％，55．5％，68．1％；中位年龄55岁，≤55岁年龄组和＞55岁年龄组的3年无瘤生存率（66．7％VS 53．1％，P＝0．006）和3年总生存率（82．4％VS 52．7％，P＝0．009）有统计学差异；3年局部控制率（93．6％ VS 86．1％，P＝0．171）和3年无转移生存率（73．6％VS 64．8％，P＝0．292），无统计学差异。单纯放疗与放化疗综合治疗组3年总生存率分别为56．2％VS 76．7％（P＜0．05），不同放化疗综合治疗模式（放疗＋辅助化疗、诱导化疗＋放疗、同步放化疗、诱导化疗＋放疗＋辅助化疗）间的总生存率、无瘤生存率和无远处转移生存率均无统计学差异。结论 IMRT联合化疗较单纯IMRT治疗可提高鼻咽癌的3年总生存率，远处转移是鼻咽癌IMRT治疗失败和死亡的主要原因，单因素分析显示年龄是预后的影响因素。

Retrospective Studies on Long-term Results in 119 Nasopharyngeal Carcinoma Treated with Intensity Modulated Radiotherapy

Objective To investigate the long-term outcomes and prognostic factors of patients with naso-pharyngeal carcinoma treated with intensity modulated radiotherapy （ IMRT） .Methods One hundred and ninteen cases with nasopharyngeal carcinoma were enrolled in the study from May 2005 to December 2011 in Weifang People＇s Hospi-tal,including 52 patients treated with radiotherapy alone and 67 patients treated with chemoradiotherapy .The prescribed dose for GTVnx,GTVnd,CTVl and CTV2 were GTVnx 66-73Gy,GTVnd 66-68Gy,CTV1 60-66Gy,CTV2 54-59Gy respectively .The local control rate （ LC ） , overall survival （ OS ） , disease free survival （ DFS ） and distant metastasis-free sunrival（DMF） were estimated by Kaplan-Meier method.Results All patients completed IMRT.The median follow-up time was 30 months（1.6-85.3 months）.Nine and 33 patients had local recurrence ,regional recurrence and distant me-tastasis respectively.Three years LC,DMF,DFS,OS were 90.2%,69.6%,55.5%,68.1%.Between the median age of 55 years old group and other group,3-year LC were 93.6%VS 86.1%（P=0.171）,DFS 66.7% VS 53.1%（P=0. 006）,DMF 73.6%VS 64.8%（P=0.292） and OS 82.4%VS 52.7%（P=0.009）.Radiotherapy alone and combined therapy group 3-years OS were 56.2%VS 76.7%（P〈0.05）.There were no significant difference on survival among different radiotherapy combined mode .Conclusion In the aspect of OS ,radiotherapy alone group were lower than those combined therapy group .Distant metastasis is the main cause of treatment failure and death in nasopharyngeal carcinoma IMRT and Single factor analysis showed that age is the influence factors of prognosis .