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目的分析局部残留和复发鼻咽癌分次立体定向放疗(FSRT)的预后因素。方法采用FSRT治疗鼻咽癌常规放疗后局部残留和复发患者共90例,除3例治疗前已发生远处转移外,余87例(34例残留,53例复发)纳入分析。其中肿瘤位于鼻咽腔内、外者分别为44、43例;中位肿瘤体积为5.7 cm3(0.8～24.7 cm3);残留和复发病灶FSRT的中位处方剂量分别为18 Gy分3次和48 Gy分6次。用Kaplan-Meier法计算无局部失败生存率(LFFS)和疾病相关生存率(DSS),用Logrank法和Cox模型分别进行单因素和多因素的预后分析。结果中位随访时间为24.9个月(3.3～86.3个月),1、2、3、4年LFFS和DSS分别为90%、83%、81%、75%和84%、77%、61%、56%。单因素分析显示肿瘤体积(≤或>5 cm3)对患者DSS有影响(P=0.015)。多因素分析显示肿瘤体积和病灶类型(残留或复发)是影响DSS的独立因素(P<0.05)。残留组和复发组晚期副反应发生率分别为9%和26%。结论FSRT治疗残留和复发鼻咽癌可得到较好局部控制率和生存率,复发病灶和较大肿瘤体积是预后不良的独立影响因素。
Objective To analyze the prognostic factors of fractional stereotactic radiotherapy (FSRT) of residual and recurrent nasopharyngeal carcinoma. Methods A total of 90 patients with local residual and recurrence of nasopharyngeal carcinoma after conventional radiotherapy were treated with FSRT. Except for 3 cases, distant metastasis occurred before treatment, 87 patients (34 residual and 53 recurrent) were included in the analysis. The median tumor size was 5.7 cm3 (0.8-24.7 cm3). The median prescribing dose of FSRT for residual and recurrent lesions was 18 Gy in 3 and 48 cases, respectively Gy points 6 times. Unfailed survival (LFFS) and disease-related survival (DSS) were calculated using the Kaplan-Meier method, and univariate and multivariate prognostic analyzes were performed using the Logrank and Cox models, respectively. Results The median follow-up time was 24.9 months (3.3-86.3 months). The LFFS and DSS at 1, 2, 3, 4 years were 90%, 83%, 81%, 75% and 84%, 77% and 61% , 56%. Univariate analysis showed that tumor volume (≤ or> 5 cm3) had an effect on DSS in patients (P = 0.015). Multivariate analysis showed that tumor volume and lesion type (residual or recurrent) were independent factors affecting DSS (P <0.05). The incidence of late side effects in residual group and recurrent group were 9% and 26% respectively. Conclusion FSRT treatment of residual and recurrent nasopharyngeal carcinoma can get a better local control and survival rate, recurrence and larger tumor volume is an independent prognostic factor.