本文選題：鼻咽腫瘤　切入點：放射療法　出處：《汕頭大學》2011年碩士論文

【摘要】：背景與目的:鼻咽癌的生物學特點與頸部淋巴結(jié)轉(zhuǎn)移的發(fā)生有關(guān),所以N0期鼻咽癌在腫瘤生物學特點上與存在頸部淋巴結(jié)轉(zhuǎn)移的鼻咽癌也可能有所不同。目前對N0期鼻咽癌的放療療效及治療后的失敗模式尚缺乏專門的探討。本研究通過對N0期鼻咽癌患者臨床資料的回顧性研究,分析患者的生存情況以及探討其治療失敗模式,希望有助于進一步優(yōu)化目前的治療模式,改善患者的預后。 方法:收集1989年5月至2009年10月610例N0期鼻咽癌患者的臨床資料,所有患者治療前均行顱底鼻咽部CT掃描。采用60Co治療機γ線或直線加速器6MV-X線進行治療,常規(guī)分割、連續(xù)放療。多數(shù)病例采用面頸聯(lián)合野照射DT 36～40 Gy后改用雙耳前野加雙上頸切線野照射。鼻咽原發(fā)病灶外照射劑量為34～91 Gy(中位劑量為70 Gy),頸部外照射劑量為34～70 Gy(中位劑量為50 Gy)。全組病例中共有68例患者接受雙側(cè)全頸或1側(cè)全頸1側(cè)上半頸預防照射,其余542例全部接受雙側(cè)上半頸預防照射。65例患者接受了放化療綜合治療。外照射DT 70～72 Gy結(jié)束后共有99例患者存在鼻咽病灶殘留,殘留病灶加用腔內(nèi)192Ir后裝治療或者小野適形外照射推量放療。隨訪時間為3～254個月,中位隨訪時間為65.0個月。生存率分析采用Kaplan-Meier方法進行計算,Log-rank法檢驗差異顯著性,Cox比例風險模型進行多因素分析。 結(jié)果:5年和10年的生存結(jié)果:總生存率分別為78.7%和66.8%,無病生存率分別為68.8%和55.8%,疾病相關(guān)生存率分別為79.9%和70.4%,局部無失敗生存率分別為81.2%和72.5%,區(qū)域無失敗生存率分別為95.8%和91.8%,局部區(qū)域無失敗生存率分別為78.3%和68.5%,無遠處轉(zhuǎn)移生存率分別為88.5%和85.5%。全組病例中頸部淋巴結(jié)復發(fā)31例(5.1%),以單純頸部淋巴結(jié)復發(fā)為放療后首發(fā)失敗事件的15例(2.5%)。在全部有頸淋巴結(jié)復發(fā)的病人中,照射野內(nèi)復發(fā)16例(2.6%),照射野外復發(fā)13例(2.1%),照射野內(nèi)及野外復發(fā)2例(0.3%)。治療后首次失敗事件中,單純局部失敗100例,占所有失敗患者的52.1%(100/192);單純遠處失敗52例,占所有失敗患者的27.1%(52/192)。多因素分析結(jié)果顯示T分期是影響N0期鼻咽癌患者預后的獨立因素(P = 0.000)。T分期(P = 0.000)、男性(P = 0.039)和貧血(P = 0.007)是影響無病生存率的獨立不良預后因素。 結(jié)論:N0期鼻咽癌患者有較好的預后,局部失敗是治療失敗的主要原因,提高局部控制率將有助于延長患者的生存期。影響N0期鼻咽癌患者總生存率唯一的獨立預后因素是T分期,影響無病生存率的獨立不良預后因素是T分期、男性和貧血。
[Abstract]:Background & objective: the biological characteristics of nasopharyngeal carcinoma are related to the occurrence of cervical lymph node metastasis, so the biological characteristics of N0 nasopharyngeal carcinoma may be different from those of nasopharyngeal carcinoma with cervical lymph node metastasis.At present, there is a lack of specific discussion on radiotherapy efficacy and failure mode after treatment of N 0 nasopharyngeal carcinoma.In this study, the clinical data of N0 stage nasopharyngeal carcinoma patients were retrospectively studied, and the survival status and failure mode of N0 nasopharyngeal carcinoma patients were analyzed in order to further optimize the current treatment mode and improve the prognosis of the patients.Methods: the clinical data of 610 patients with stage N 0 nasopharyngeal carcinoma from May 1989 to October 2009 were collected.緯-ray of 60Co therapy machine or 6MV-X line of linear accelerator were used for treatment, routine fractionation and continuous radiotherapy.Most of the patients were irradiated with DT36 ~ 40 Gy in the face and neck combined field and then were irradiated with the anterior field of both ears and the tangent field of the double upper neck.The external dose of nasopharynx primary lesion was 3491 Gy (median dose was 70 Gy) and external dose of neck was 3470 Gy (median dose was 50 Gy).A total of 68 patients were treated with prophylactic irradiation on bilateral neck or 1 side of upper neck, and the remaining 542 cases were treated with combined radiotherapy and chemotherapeutic therapy in all. 65 cases were treated with prophylaxis and chemotherapeutic therapy.After the end of DT70 ~ 72Gy, there were 99 patients with residual nasopharynx lesions. The residual lesions were treated with intracavitary 192Ir afterloading or small-field conformal external irradiation and extrapolation radiotherapy.The follow-up time was 3 ~ 254 months and the median follow-up time was 65.0 months.Survival rate analysis Kaplan-Meier method was used to calculate Log-rank test difference significant Cox proportional risk model was used to carry out multivariate analysis.Results: the overall survival rate was 78.7% and 66.8%, the disease-free survival rate was 68.8% and 55.8%, the disease-related survival rate was 79.9% and 70.4%, the local failure free survival rate was 81.2% and 72.5%, the regional failure free survival rate was 81.2% and 72.5%, respectively.The local failure free survival rate was 78.3% and 68.5%, and the distant metastasis free survival rate was 88.5% and 85.5%, respectively.There were 31 cases of cervical lymph node recurrence in the whole group, and 15 cases with cervical lymph node recurrence as the first failure event after radiotherapy.Among all the patients with cervical lymph node recurrence, 16 cases had recurrence in the irradiation field, 13 cases had the recurrence in the field, 2 cases had the recurrence in the field and 2 cases had the recurrence in the field.In the first failure event after treatment, 100 cases were local failure, accounting for 52.1% / 100% of all failure patients, and 52 cases were simple distant failure, accounting for 27.1 / 52% of all failure patients.Multivariate analysis showed that T stage was an independent factor affecting the prognosis of N0 NPC patients (P = 0.0000.000, P = 0.000, P = 0.039) and anemia (P = 0.007) was an independent and adverse prognostic factor for disease-free survival.Conclusion the patients with stage N 0 nasopharyngeal carcinoma have good prognosis. Local failure is the main cause of failure in treatment. Increasing local control rate will help prolong the survival time of patients.T stage was the only independent prognostic factor affecting the overall survival rate of N0 NPC patients, and T stage, male and anemia were the independent adverse prognostic factors affecting the disease-free survival rate.
【學位授予單位】：汕頭大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R739.63

【參考文獻】

相關(guān)期刊論文 前2條

1 陳奇松;林少俊;潘建基;張瑜;林錦;陳英;宗井鳳;盧濤;;779例鼻咽癌頸部淋巴結(jié)轉(zhuǎn)移規(guī)律分析[J];中國癌癥雜志;2010年01期

2 陳創(chuàng)珍,李德銳,陳志堅,郭z，

本文編號：1726397