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目的分析鼻咽癌治疗失败的主要原因并探讨提高生存率的方法。方法１９８８年４月至１９９１年１２月，共收治鼻咽癌２６５例，其中Ⅰ期５例，Ⅱ期７３例，Ⅲ期１１３例，Ⅳ期７４例，年龄１３～７８岁。采取６０Ｃｏ及深部Ｘ线照射。原发灶剂量６０～８０Ｇｙ／６～８ＷＫｓ，颈转移灶５５～７４Ｇｙ／５～７ＷＫｓ。对Ｎ２和Ｎ３中分单放与放疗前ＤＤＰ，５－Ｆｕ诱导化疗。随机分组各５０例。结果总５年生存率３８．５％。Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为８０．０％、６１．６％、３６．３％、１６．２％。局部复发和远处转移是治疗失败的主要原因。结论早期诊治是提高生存率的关键，减少原发灶复发应以ＣＴ为准。合理设计照射野，建议将常规耳前野的后界延至外耳孔后缘１～２厘米；对超腔、累及口咽、咽旁间隙、茎突后间隙及伴颈深上淋巴结转移者尽量使用面颈联合野，放疗前诱导化疗对Ｎ２和Ｎ３病例近期疗效满意。
Objective To analyze the main causes of treatment failure in nasopharyngeal carcinoma and to explore ways to improve survival. Methods From April 1988 to December 1991, a total of 265 cases of nasopharyngeal carcinoma were treated, including 5 cases in stage I, 73 cases in stage II, 113 cases in stage III, 74 cases in stage IV, and ages from 13 to 78 years. Take 60Co and deep X-rays. The primary tumor dose was 60-80 Gy/6-8 WKs, and the cervical metastases were 55-74 Gy/5-7 WKs. N2 and N3 were divided into single radiotherapy and radiotherapy before DDP, 5-Fu induction chemotherapy. Randomly grouped 50 cases. The overall 5-year survival rate was 38.5%. Phases I, II, III, and IV were 80.0%, 61.6%, 36.3%, and 16.2%, respectively. Local recurrence and distant metastasis are the main reasons for treatment failure. Conclusions Early diagnosis and treatment is the key to improve survival rate. The reduction of primary tumor recurrence should be based on CT. Reasonably designing the radiation field, it is recommended to extend the posterior boundary of the conventional preauricular field to the posterior edge of the outer ear hole by 1 to 2 cm; use the surface as far as possible for the hypercavity, involving the oropharynx, parapharyngeal space, posterior styloid process space, and cervical lymph node metastasis. Neck combined fields and induction chemotherapy before radiotherapy were satisfactory for the short-term effects of N2 and N3 cases.