本文關(guān)鍵詞： 鼻咽癌 調(diào)強放療 生存率 放療副反應(yīng)　出處：《廣西醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的:對比研究調(diào)強放療與常規(guī)放療治療鼻咽癌的有效率;1年、2年、3年總生存率、無進(jìn)展生存率、局部區(qū)域控制率及放療副反應(yīng),比較調(diào)強放療與常規(guī)放療的差異,調(diào)強放療能否提高鼻咽癌患者有效率、提高生存率及降低副反應(yīng)。 方法:隨機收集2005年1月到2007年1月到我院就診并接受治療的60例調(diào)強放療的初治鼻咽癌患者,排除遠(yuǎn)處轉(zhuǎn)移,并以“鼻咽癌92分期”為標(biāo)準(zhǔn),在同期二維常規(guī)放射治療的患者中隨機選取60例作為對照組,要求兩組的年齡、性別及分期均無統(tǒng)計學(xué)差異。比較兩組的療效及放療副反應(yīng)。調(diào)強放療組采用同步推量放療方法給予靶體積處方劑量,GTVnx:T1、T2患者總量為69.9Gy,分30次,每次2.33Gy,T3、T4患者總量為73.9Gy,分32次,每次2.31Gy;GTVnd、CTV1、CTV2分別為66 Gy、60 Gy、54Gy,均30分次;陽性淋巴結(jié)復(fù)查有殘留再加量至70Gy。常規(guī)放療組采用兩側(cè)面頸聯(lián)合大野加兩側(cè)面頸聯(lián)合小野,下頸用切線照射加電子線,使用常規(guī)分割、常規(guī)劑量,2 Gy/次,5次/周。第一段采用面頸聯(lián)合左右對穿野和下頸前切線野。照射DT36Gy;第二段避脊髓,照射DT 50Gy;第三段避腦干,照射DT66Gy;第四段照射至根治量,鼻咽部劑量70～76 Gy,陽性淋巴結(jié)劑量66Gy,復(fù)查有殘留再加量至70Gy。兩組中的Ⅲ期、Ⅳa期患者放療期間同時行同步化療,化療方案參考NCCN指南:順鉑40mg/m~2,每周進(jìn)行。 結(jié)果:(1)放療結(jié)束時、放療結(jié)束后3個月分別復(fù)查,調(diào)強放療組CR率、治療有效率均顯著好于常規(guī)放療組,差異有統(tǒng)計學(xué)意義(P0.05);(2)調(diào)強放療組與常規(guī)放療組相比,1年、2年、3年的總生存率、無進(jìn)展生存率及局部區(qū)域控制率均無明顯差異(P0.05);(3)調(diào)強組患者的急性皮膚反應(yīng)、口干、張口受限等副反應(yīng)明顯低于常規(guī)組,差異有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論:(1)與常規(guī)放療相比,調(diào)強放療能提高鼻咽癌患者的完全緩解率及有效率;(2)與常規(guī)放療相比,調(diào)強放療組并未提高1年、2年、3年總生存率、無進(jìn)展生存率、局部區(qū)域控制率;(3)與常規(guī)放療相比,調(diào)強放療能降低急性皮膚反應(yīng)、口干、張口受限等副反應(yīng)的發(fā)生,提高患者生活質(zhì)量。
[Abstract]:Objective: to compare the effective rate of intensity modulated radiotherapy (IMRT) with conventional radiotherapy, 1 year, 2 years, 3 years overall survival rate, progression free survival rate, local area control rate and side effects of radiotherapy, and compare the difference between intensity modulated radiotherapy and conventional radiotherapy. Intensity-modulated radiotherapy can improve the effective rate, increase the survival rate and reduce the side effects of nasopharyngeal carcinoma patients. Methods: from January 2005 to January 2007, 60 patients with nasopharyngeal carcinoma treated by intensity modulated radiotherapy were randomly collected, and distant metastasis was excluded. In the same period, 60 patients with conventional radiotherapy were randomly selected as the control group, asking for the age of the two groups. There was no statistical difference in sex and stage. The curative effect and the side effects of radiotherapy were compared between the two groups. The total dose of GTVnx: T1 / T2 in IMRT group was 69.9 Gy, 30 times, the total number of T3 T4 patients was 73.9 Gy, 32 times. The CTV2 of GTVndT CTV1 was 66 Gy / 60 Gy / 54.The positive lymph nodes had a residual dose of 70 Gy.The conventional radiotherapy group was treated with two sides of neck combined with large field plus two sides of neck combined with small field, and the lower neck was irradiated with tangent line plus electron line, and the routine segmentation was used. The patients in the conventional radiotherapy group were treated with two sides of neck combined with big field plus two sides of the neck combined with small field, and the lower neck was irradiated with tangent line plus electron line. The first segment was exposed to DT36Gy with the right and left of the faciocervical joint and the anterior tangent field of the lower neck. The second segment of the spinal cord was irradiated with DT50 Gy; the third segment of the brain stem was irradiated with DT66 Gy; and the fourth segment was irradiated to the radical dose. The nasopharynx dose was 70 ~ 76 Gy, the positive lymph node dose was 66 Gy, and the residual additional dose was 70 Gy. The patients in the two groups underwent concurrent chemotherapy during radiotherapy for stage 鈪，

本文編號：1506078