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目的探讨鼻咽癌调强放疗(intensity modulated radiation therapy,IMRT)的实施,观察近期疗效,并分析其急慢性不良反应。方法鼻咽癌IMRT初治患者180例,按1992年福州分期标准,Ⅰ期13例,Ⅱ期52例,Ⅲ期86例,Ⅳ期29例;鼻咽和上颈淋巴引流区作IMRT,原发灶GTV照射中位剂量72.6Gy(70.4~83.6Gy),2.2 Gy/f,下颈淋巴引流区予颈前切线野照射,50~70Gy/2Gy/f。结果随访中位时间24个月(12~48个月),1、2年总生存率分别为100%、94.4%,1、2年无局部复发率分别为96.4%、93.3%,无区域进展生存率分别为98.3%、97.5%,无远处转移生存率分别为90.1%、82.4%。N分期是影响无远处转移生存率的最重要预后因素(P=0.04)。最严重的急性不良反应是放射性黏膜炎,Ⅰ~Ⅳ级分别为26.6%、43.8%、23.3%、1.1%。晚期不良反应主要表现为口干,Ⅰ级37.2%,Ⅱ级7.3%。结论鼻咽癌IMRT靶区剂量高,周围正常组织受量小,不良反应轻微,是一种治疗鼻咽癌的有效方法。
Objective To investigate the implementation of intensity modulated radiation therapy (NPC) for nasopharyngeal carcinoma (NPC) and to observe the short-term curative effect and to analyze its acute and chronic adverse reactions. Methods A total of 180 patients with nasopharyngeal carcinoma (IMRT) were enrolled in this study. According to the 1992 Fuzhou staging system, 13 cases were stage Ⅰ, 52 cases were stage Ⅱ, 86 cases were stage Ⅲ, 29 cases were stage Ⅳ. The lymphatic drainage area of the nasopharynx and the upper neck was used as IMRT, The median dose of focal GTV irradiation was 72.6Gy (70.4 ~ 83.6Gy), 2.2 Gy / f, and the lower cervical lymphatic drainage area was irradiated to the anterior cervical trochanter, 50-70Gy / 2Gy / f. Results The median follow-up time was 24 months (range, 12-48 months). The overall survival rates at 1 and 2 years were 100% and 94.4% respectively. No local recurrence rates were 96.4% and 93.3% at 1 and 2 years, respectively, with no regional progress Survival rates were 98.3% and 97.5%, respectively, and distant metastasis-free survival rates were 90.1% and 82.4% respectively. N staging was the most important prognostic factor affecting distant metastasis-free survival (P = 0.04). The most serious acute adverse reaction is radiation mucositis, Ⅰ ~ Ⅳ grade were 26.6%, 43.8%, 23.3%, 1.1%. Late adverse reactions mainly manifested as dry mouth, Ⅰ grade 37.2%, Ⅱ grade 7.3%. Conclusion IMRT nasopharyngeal carcinoma target dose is high, around the normal tissue by a small amount of adverse reactions, is an effective method of treatment of nasopharyngeal carcinoma.