本文選題：鼻咽癌 + 調(diào)強(qiáng)適形放療��； 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的 通過回顧性分析鼻咽癌調(diào)強(qiáng)放療后復(fù)發(fā)患者的臨床資料,初步探討鼻咽癌調(diào)強(qiáng)放療后復(fù)發(fā)的臨床特征與規(guī)律,為進(jìn)一步提高鼻咽癌的調(diào)強(qiáng)放療療效提供依據(jù),進(jìn)而提高局部控制率、生存率。資料與方法收集2009年1月至2014年12月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院放療科調(diào)強(qiáng)放療后復(fù)發(fā)的49例鼻咽癌患者的臨床資料,對復(fù)發(fā)時間、部位、分期、靶區(qū)及劑量等因素進(jìn)行分析。等級資料采用秩和檢驗,通過SPSS16.0統(tǒng)計軟件進(jìn)行統(tǒng)計分析,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果1.復(fù)發(fā)中位時間為20個月,放療后6-12個月復(fù)發(fā)的病例占8.2%,12～18個月復(fù)發(fā)的占34.7%,18～24個月復(fù)發(fā)的占22.4%,24～30個月復(fù)發(fā)的占26.5%,30-36個月復(fù)發(fā)的占2.0%,放療后3年內(nèi)累計復(fù)發(fā)的病例占93.9%,3年復(fù)發(fā)的病例僅有6.1%。2.單純局部復(fù)發(fā)為57.1%(28/49),單純區(qū)域復(fù)發(fā)為22.4%(11/49),局部+區(qū)域復(fù)發(fā)為20.4%(10/49)。局部復(fù)發(fā)受侵概率較高的部位有：巖尖(60.5%)、斜坡(57.9%)、蝶骨基底部(55.2%)、翼腭窩(47.3%)、翼突(44.7%)。區(qū)域復(fù)發(fā)21例(42.8%)分布,Ⅱ區(qū)57.1%,Ⅲ區(qū)23.8%,Ⅳ區(qū)9.5%,鎖骨下區(qū)4.8%,腮腺后緣下區(qū)4.8%。3.49例復(fù)發(fā)患者按2009’UICC/AJCC分期后為：Ⅰ期4.1%(2/49),Ⅱ期24.5%(12/49),Ⅲ期26.5%(13/49),Ⅳa期40.8%(20/49),Ⅳb期4.1%(2/49),根據(jù)2009’UICC/AJCC分期系統(tǒng)回顧鼻咽癌分期(原分期)：Ⅱ期6.1%(3/49),m期40.8%(20/49),Ⅳa期51.0%(25/49),Ⅳb期2.0%(1/49)。通過Wilcoxon秩和檢驗對原分期和復(fù)發(fā)分期比較：12.2%(6/49)患者復(fù)發(fā)的T分期比原T分期更晚期,然而,51.0%(25/49)原T分期比復(fù)發(fā)T分期更晚期(P=-0.029)；有57.1%(28/49)復(fù)發(fā)患者N分期比原N分期更早期,然而,8.2%(4/49)的原N分期比復(fù)發(fā)N分期更加早期(P=-0.001),有34.7%患者復(fù)發(fā)是N分期與原N分期相同。對于總TNM分期,16.3%(8/49)患者復(fù)發(fā)臨床分期比原臨床分期更加晚期,然而,38.8%(19/49)原臨床分期比復(fù)發(fā)臨床分期更加晚期(P0.005)。4.野內(nèi)復(fù)發(fā)的47例患者(單純局部復(fù)發(fā)28例,局部+區(qū)域復(fù)發(fā)10例,區(qū)域復(fù)發(fā)9例)；野外復(fù)發(fā)2例(左腮腺后緣復(fù)發(fā)1例,左鎖骨下區(qū)淋巴結(jié)復(fù)發(fā)1例)。結(jié)論1.鼻咽癌調(diào)強(qiáng)放療后復(fù)發(fā)的中位時間為20個月,且大部分在3年內(nèi)。2.鼻咽癌調(diào)強(qiáng)放療后的復(fù)發(fā)部位,鼻咽部以顱底多見,頸部以Ⅱ區(qū)為主。3.調(diào)強(qiáng)放療后的復(fù)發(fā)大部分為野內(nèi)復(fù)發(fā)。
[Abstract]:Objective through retrospective analysis of the clinical data of recurrent nasopharyngeal carcinoma after intensity modulated radiotherapy, the clinical characteristics and regularity of recurrent nasopharyngeal carcinoma after intensity modulated radiotherapy were preliminarily discussed in order to provide a basis for further improving the effect of intensity modulated radiotherapy for nasopharyngeal carcinoma, and then to improve the local control rate and survival rate. Data and methods were collected from January 2009 to December 2014. The clinical data of 49 cases of nasopharyngeal carcinoma relapsed after intensity modulated radiotherapy in the First Affiliated Hospital of West Medical University were analyzed. The recurrence time, location, stage, target area and dose were analyzed. Rank sum test was used and statistical analysis was carried out by SPSS16.0 statistical software. The difference of P0.05 was statistically significant. Results 1. relapse. The time was 20 months, the recurrence of 6-12 months after radiotherapy accounted for 8.2%, 12~18 months recrudescence 34.7%, 18~24 months recrudescence 22.4%, 24~30 months recrudescence 26.5%, 30-36 months relapse 2%, recurrent cases within 3 years after radiotherapy accounted 93.9%, only 6.1%.2. local recurrence (28/49), only recurrent cases relapsed years, simple Regional recurrence was 22.4% (11/49) and local recurrence was 20.4% (10/49). Local recurrence was higher in the region of rock tip (60.5%), slope (57.9%), basal part of sphenoid bone (55.2%), pterygopalatine fossa (47.3%), pterygopalatine (44.7%). Regional recurrence 21 cases (42.8%), 57.1%, III region 23.8%, IV region 9.5%, subclavian 4.8%, 4.8%.3.4 in the lower parotid region. 9 cases of recurrent patients were followed by 2009 'UICC/AJCC stages: stage I 4.1% (2/49), stage II 24.5% (12/49), stage III 26.5% (13/49), stage IV A 40.8% (20/49), stage IV B 4.1% (2/49), according to 2009' UICC/AJCC stage system review of nasopharyngeal carcinoma staging (stage 6.1% (3/49), M phase 40.8% (20/49), IV 51%, IV 2% period 2%). The rank sum test compared the original staging and recurrence staging: 12.2% (6/49) patients had more advanced T stages than original T staging, however, 51% (25/49) T staging was more advanced than that of recurrent T staging (P=-0.029), and 57.1% (28/49) recurred patients were more early than original N staging, but 8.2% (4/49) primary N staging was earlier than recurrent staging. The recurrence of 34.7% patients was the same as the N staging and the original N staging. For the total TNM staging, the recurrent clinical stages of the 16.3% (8/49) patients were more advanced than the original clinical staging. However, the 38.8% (19/49) primary clinical staging was more advanced than the recurrent clinical staging (P0.005) in the.4. intratumoral recurrence (28 cases of local recurrence, 10 local recurrent cases, regional relapse, and regional relapse. In 9 cases, there were 2 cases of field recurrence (1 cases of left parotid posterior margin recurrence and 1 cases of left subclavian lymph node recurrence). Conclusion the median time of recurrence of 1. nasopharyngeal carcinoma after intensity modulated radiotherapy is 20 months, and most of the recurrent sites of.2. nasopharyngeal carcinoma after intensity modulated radiotherapy in 3 years, the nasopharynx is more common in the skull base, and the recurrence of the neck is mainly after the.3. intensity modulated radiotherapy in the second region of the neck region. It is divided into a recurrence in the field.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R739.63

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