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目的回顾性分析全部靶区、全程同期整合补量调强放疗(whole-field simultaneous integrated-boost intensity-modulated radiotherapy,WF-SIB IMRT)鼻咽癌的效果。方法 2005年10月至2009年11月经病理证实的42例鼻咽癌患者接受调强放疗(intensity-modulated radiotherapy,IMRT),I～IIb期13例,III～IVb期29例。处方:(gross target volumes,GTV)2.1～2.3 Gy/次,(clinical target volumes 1,CTV1)1.9～2.0 Gy/次、(clinical target volumes 2,CTV2)1.8 Gy/次,放射总剂量分别为70～80.5、62.7～70.0、50.4 Gy。12例患者治疗后有病灶残存,局部立体定向照射5～18.9 Gy。RTOG评分标准记录照射反应,Kaplan-Meier法计算生存率。结果中位随访时间32个月(12～63个月),4年局部控制率、区域控制率、无转移生存率和总生存率分别为93.0%、97.4%、74.0%和86.2%;急性反应主要为1～2级黏膜和唾液腺反应,分别为90.5%和85.7%;晚期为1级口干(47.6%)。结论 IMRT鼻咽癌靶区达到了较理想的剂量分布,并降低了周围危及器官剂量。局部、区域控制率高,降低了3～4级急、慢性反应,失败的主要原因是远处转移。
Objective To retrospectively analyze the effect of whole-field simultaneous integrated-boost intensity-modulated radiotherapy (WF-SIB IMRT) on nasopharyngeal carcinoma in all target areas. Methods Forty-two patients with nasopharyngeal carcinoma confirmed by pathology from October 2005 to November 2009 underwent intensity-modulated radiotherapy (IMRT), 13 cases were treated with stage I-IIb and 29 cases were treated with stage III-IVb. Patients undergoing gross target volumes (GTV) of 2.1-2.3 Gy / second (clinical target volumes 1, CTV1 1.9-2.0 Gy / second clinical trial, CTV2 1.8 Gy / second, total radiation dose 70 ~ 80.5, 62.7 ~ 70.0, 50.4 Gy. After treatment, 12 patients had residual lesions, and local stereotactic irradiation was 5 ~ 18.9 Gy. RTOG score recorded irradiation response, Kaplan-Meier method to calculate survival rate. Results The median follow-up time was 32 months (range, 12 to 63 months). The 4-year local control rate, regional control rate, metastasis-free survival rate and overall survival rate were 93.0%, 97.4%, 74.0% and 86.2% Mucosal and salivary glands were mainly grade 1 to grade 2, with 90.5% and 85.7%, respectively; grade 1 dry mouth (47.6%). Conclusion IMRT nasopharyngeal carcinoma target area to achieve a more ideal dose distribution, and reduce the risk of organ damage around the dose. Local, regional control rate is high, reducing grade 3 to 4 acute and chronic reactions, the main reason for failure is distant metastasis.