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目的 探讨晚期和复发头颈癌立体定向放射治疗的近期疗效、并发症等。方法 1997年 10月至 1998年 10月采用立体定向放射治疗 (SRT)晚期和复发的头颈癌 2 8例。其中NPC17例 ,鼻腔副鼻窦肿瘤 4例 ,舌根癌 3例、喉癌 2例、颈段椎管内髓外肿瘤术后残留外侵 1例 ,软腭癌 1例。肿瘤体积较大 ,最大径 2 .5～ 7.0cm ,中位数 4.5cm ,15例患者有严重的局部疼痛等症状 ,3例有鼻阻塞、出血。照射剂量 4～ 8Gy/次 ,隔日 1次 ,总剂量 2 0～ 40Gy ,中位剂量 32Gy ,靶区边缘等剂量线为 5 0 %～ 80 %。结果 13例NPC患者头部剧痛得到迅速缓解 ,2例舌根癌治疗结束后 2周疼痛逐渐缓解 ,STR止痛有效率达 10 0 %。 3例鼻腔副鼻窦肿瘤消退 ,鼻塞、鼻衄症状消失。 1例NPC二程放疗后复发患者治疗后颅神经损害症状加重 ,舌根癌、喉癌等局部粘膜反应较重。 1例NPC患者治疗后 4月死于鼻咽出血 ,1例NPC患者 3月后死于全身衰竭 ,1例鼻腔副鼻窦NHL患者 4月后死于全身播散。结论 SRT对晚期和复发的头颈癌具有显著的姑息减症作用 ,特别适合于放疗后复发且无其它有效疗法的患者 ,但其并发症也值得重视。SRT也适合于靠近眼球、颈髓等需特别保护器官肿瘤的治疗。
Objective To investigate the short-term curative effect and complications of stereotactic radiotherapy for advanced and recurrent head and neck cancer. Methods From October 1997 to October 1998, 28 patients with advanced and recurrent head and neck cancer were treated with stereotactic radiotherapy (SRT). There were 17 cases of NPC, 4 cases of paranasal sinuses, 3 cases of tongue carcinoma, 2 cases of laryngeal carcinoma, 1 case of residual invasion of cervical intramedullary extramedullary tumor and 1 case of soft palate cancer. Tumor volume larger, maximum diameter 2.5 ~ 7.0cm, median 4.5cm, 15 patients had severe local pain and other symptoms, nasal obstruction in 3 cases, bleeding. The irradiation dose was 4 ~ 8Gy / time, every other day, the total dose of 20 ~ 40Gy, the median dose of 32Gy, the target edge of the dose line is 50% to 80%. Results The pain of the head was relieved rapidly in 13 NPC patients. The pain relief was relieved 2 weeks after 2 cases of tongue base cancer, and the effective rate of STR analgesia was 100%. 3 cases of nasal sinus pain subsided, nasal congestion, epistaxis symptoms disappear. One case of NPC recurrence after two-way radiotherapy in patients with cranial nerve injury symptoms worse, tongue cancer, laryngeal cancer and other local mucosal reactions heavier. One patient with NPC died of nasopharyngeal hemorrhage 4 months after treatment, one patient with NPC died of systemic failure 3 months later, and one patient with nasal paranasal NHL died of systemic dissemination 4 months later. Conclusions SRT has a significant palliative effect on advanced and recurrent head and neck cancer. It is especially suitable for patients who have relapsed after radiotherapy and have no other effective therapy. However, their complications are worthy of attention. SRT is also suitable for the treatment of tumors that require special protection of the organs near the eye, cervical spinal cord and the like.