鼻咽癌殘存病灶分次立體定向放射治療臨床研究
發(fā)布時(shí)間：2018-08-14 11:39
【摘要】：第一部分分次立體定向放療在殘存鼻咽癌治療中的作用 目的：總結(jié)我院應(yīng)用分次立體定向放療(FSRT)推量治療鼻咽癌根治性外照射后殘存病灶的結(jié)果,進(jìn)一步探討分次立體定向放療在局部殘存鼻咽癌治療中的作用。 資料和方法：回顧性分析我院放療科2000年1月至2009年12月收治的136例首程根治性放療后局部殘存鼻咽癌患者資料。男性104例(76.5%),女性32(23.5%)例；中位年齡43.0歲(13-77歲)；初診分期(2002年UICC)為：Ⅰ期1例(0.8%),Ⅱ a期6例(4.4%),Ⅱ b期24例(17.6%),Ⅲ期70例(51.5%),Ⅳa期24例(17.6%),Ⅳb期11例(8.1%)。首程放療鼻咽部總劑量為68.0-78.0Gy(中位劑量70.0Gy),其中常規(guī)放療85例,調(diào)強(qiáng)放療51例。首程放療與FSRT的中位時(shí)間為24.5天。殘存病灶體積為0.60-77.13cm3(中位體積13.45cm3)。FSRT總劑量為8.0-32.0Gy(中位劑量19.5Gy),單次劑量2.0-10.0Gy/次(33例5Gy,103例≤5Gy)。FSRT的BED為10.1-44.8Gy(中位數(shù)為28Gy)。應(yīng)用Kaplan-Meier和Cox回歸分析研究各因素對(duì)預(yù)后的影響。 結(jié)果：完全緩解率為72.1%,部分緩解率為23.5%。全組病人的5年無局部失敗生存率(LFFS)、5年無遠(yuǎn)轉(zhuǎn)生存(FFDM)率、5年總生存率(OS)和5年無病生存率(DFS)分別為92.5%,77.0%,76.2%和73.6%。36例(26.8%)在FSRT后出現(xiàn)遠(yuǎn)處轉(zhuǎn)移(中位時(shí)間9個(gè)月)。Ⅰ+Ⅱ期和Ⅲ+Ⅳ期患者的5年LFFS分別為89.9%和93.3%,DFS分別為83.2%和70.8%,OS分別為86.3%和70.7%；均無統(tǒng)計(jì)學(xué)差異。19例出現(xiàn)晚期并發(fā)癥(8例顱神經(jīng)損傷,5例鼻咽部大出血,6例顳葉壞死)。多因素分析顯示T分期是DFS和OS的獨(dú)立預(yù)后因素,年齡是OS的另一預(yù)后因素。 結(jié)論：分次立體定向放射治療對(duì)鼻咽癌放療后殘存病灶的推量治療有顯著臨床療效,嚴(yán)重晚期并發(fā)癥的發(fā)生率可接受。改進(jìn)的劑量分割模式可減少晚期并發(fā)癥的發(fā)生。 第二部分保護(hù)頸動(dòng)脈鞘的鼻咽癌立體定向推量放療初探 目的：本研究采用保護(hù)頸鞘技術(shù)的分次立體定向放療推量治療鼻咽癌根治性外照射后殘存病灶,評(píng)價(jià)其療效及其并發(fā)癥。 材料與方法：2006年8月至2010年8月,36例我院鼻咽癌初程根治性放療后局部殘存患者接受分次立體定向放射治療(FSRT)推量�；颊咧形荒挲g41.3歲(13-76歲),男性25例,女性11例。初診UICC2002分期為Ⅱa期2例,Ⅱ b期5例,Ⅲ期18例,Ⅳa期7例,Ⅳb期4例。殘存腫瘤部位為：限于鼻咽腔(52.8%),鼻咽腔并咽旁間隙(8.3%),咽后淋巴結(jié)(19.4%),鼻咽腔并咽后淋巴結(jié)(13.9%),咽旁間隙并咽后淋巴結(jié)(2.8%),海綿竇(2.8%)。首程放療鼻咽部總劑量69.96-76.90Gy(中位劑量72.58Gy),其中常規(guī)放療9例,調(diào)強(qiáng)放療27例,首程同步放化療20例。首程放療與FSRT的間隔時(shí)間為12-147天(中位時(shí)間39.8天)。殘存腫瘤體積為1.46cm3-32.98cm3(中位體積14.94mm3)。FSRT應(yīng)用小多葉光柵旋轉(zhuǎn)適形照射,頸動(dòng)脈鞘受量低于2Gy/次。FSRT總劑量10.0-24.0Gy(中位劑量16.5Gy),2.0-5.0Gy/次,常用分割方式為15Gy/3Gy/5f。 結(jié)果：隨診時(shí)間為12-59月(中位時(shí)間為34月),腫瘤完全緩解率為100%。3年局部控制率為100%；3年總生存率為94.4%；3年無病生存率為77.8%。無嚴(yán)重急性放療反應(yīng)發(fā)生,晚期并發(fā)癥包括1例(2.8%)輕度后組顱神經(jīng)損傷,2例(5.6%)顳葉壞死：無鼻咽部大出血或潰瘍發(fā)生。 結(jié)論：本組立體定向放射治療劑量分割模式對(duì)首程放療后殘存鼻咽癌有顯著臨床療效,FSRT注重保護(hù)頸鞘有利于降低放療后晚期神經(jīng)、血管損傷。
[Abstract]:Part I the role of fractionated stereotactic radiotherapy in the treatment of residual nasopharyngeal carcinoma
Objective: To summarize the results of fractionated stereotactic radiotherapy (FSRT) in the treatment of residual nasopharyngeal carcinoma (NPC) after radical external irradiation.
Materials and Methods: A retrospective analysis of 136 patients with locally residual nasopharyngeal carcinoma (NPC) after first-course radical radiotherapy from January 2000 to December 2009 was carried out. 104 males (76.5%) and 32 females (23.5%) were involved; the median age was 43.0 years (13-77 years); the initial stage (2002 UICC) was stage I (0.8%), stage II a (4.4%) and stage II B (24.4%). The total dose of nasopharyngeal radiotherapy was 68.0-78.0 Gy (median dose 70.0 Gy), including 85 cases of conventional radiotherapy and 51 cases of intensity modulated radiotherapy. The BED of FSRT was 10.1-44.8 Gy (median 28 Gy). Kaplan-Meier and Cox regression were used to analyze the prognostic factors.
Results: Complete remission rate was 72.1% and partial remission rate was 23.5%. The 5-year LFFS, 5-year FFDM, 5-year OS and 5-year DFS were 92.5%, 77.0%, 76.2% and 73.6% respectively. 36 patients (26.8%) had distant metastasis after FSRT (median time was 9 months). LFFS were 89.9% and 93.3% in stage IV patients, 83.2% and 70.8% in DFS, 86.3% and 70.7% in OS, respectively. There was no significant difference between the two groups. Prime.
CONCLUSION: The fractionated stereotactic radiotherapy is effective in the treatment of residual nasopharyngeal carcinoma after radiotherapy, and the incidence of severe late complications is acceptable.
The second part of the study of stereotactic radiotherapy for nasopharyngeal carcinoma with carotid sheath protection
Objective: To evaluate the efficacy and complications of fractionated stereotactic radiotherapy with cervical sheath protection in the treatment of residual nasopharyngeal carcinoma after radical external irradiation.
Materials and Methods: From August 2006 to August 2010, 36 patients with locally residual nasopharyngeal carcinoma received fractionated stereotactic radiotherapy (FSRT). The median age was 41.3 years (13-76 years), 25 males and 11 females. The remaining tumor sites were limited to nasopharyngeal cavity (52.8%), parapharyngeal space (8.3%), retropharyngeal lymph node (19.4%), parapharyngeal space (13.9%), retropharyngeal lymph node (2.8%) and cavernous sinus (2.8%). The total dose of nasopharyngeal radiotherapy was 69.96-76.90 Gy (median dose 72.58 Gy), including 9 cases of conventional radiotherapy, 27 cases of intensity modulated radiotherapy, and 27 cases of primary radiotherapy. The interval between first-course radiotherapy and FSRT was 12-147 days (median time 39.8 days). The residual tumor volume was 1.46 cm 3-32.98 cm 3 (median volume 14.94 mm 3). FSRT was irradiated with multilobular Grating Rotational conformal radiation. The total dose of FSRT was 10.0-24.0 Gy (median dose 16.5 Gy) and 2.0-5.0 Gy (median dose 16.5 Gy) respectively. The way is 15Gy/3Gy/5f..
Results: The follow-up time was 12-59 months (median time was 34 months). The complete remission rate was 100%. The 3-year local control rate was 100%. The 3-year overall survival rate was 94.4%. The 3-year disease-free survival rate was 77.8%. There was no severe acute radiation reaction. The late complications included 1 case (2.8%) of mild cranial nerve injury in the posterior group, 2 cases (5.6%) of temporal lobe necrosis: no nasopharynx. Massive bleeding or ulceration.
Conclusion: The dose-splitting mode of stereotactic radiotherapy has a significant clinical effect on the residual nasopharyngeal carcinoma after the first-course radiotherapy. FSRT can reduce the nerve and blood vessel injury in the late stage of radiotherapy.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R739.63
本文編號(hào)：2182742
[Abstract]:Part I the role of fractionated stereotactic radiotherapy in the treatment of residual nasopharyngeal carcinoma
Objective: To summarize the results of fractionated stereotactic radiotherapy (FSRT) in the treatment of residual nasopharyngeal carcinoma (NPC) after radical external irradiation.
Materials and Methods: A retrospective analysis of 136 patients with locally residual nasopharyngeal carcinoma (NPC) after first-course radical radiotherapy from January 2000 to December 2009 was carried out. 104 males (76.5%) and 32 females (23.5%) were involved; the median age was 43.0 years (13-77 years); the initial stage (2002 UICC) was stage I (0.8%), stage II a (4.4%) and stage II B (24.4%). The total dose of nasopharyngeal radiotherapy was 68.0-78.0 Gy (median dose 70.0 Gy), including 85 cases of conventional radiotherapy and 51 cases of intensity modulated radiotherapy. The BED of FSRT was 10.1-44.8 Gy (median 28 Gy). Kaplan-Meier and Cox regression were used to analyze the prognostic factors.
Results: Complete remission rate was 72.1% and partial remission rate was 23.5%. The 5-year LFFS, 5-year FFDM, 5-year OS and 5-year DFS were 92.5%, 77.0%, 76.2% and 73.6% respectively. 36 patients (26.8%) had distant metastasis after FSRT (median time was 9 months). LFFS were 89.9% and 93.3% in stage IV patients, 83.2% and 70.8% in DFS, 86.3% and 70.7% in OS, respectively. There was no significant difference between the two groups. Prime.
CONCLUSION: The fractionated stereotactic radiotherapy is effective in the treatment of residual nasopharyngeal carcinoma after radiotherapy, and the incidence of severe late complications is acceptable.
The second part of the study of stereotactic radiotherapy for nasopharyngeal carcinoma with carotid sheath protection
Objective: To evaluate the efficacy and complications of fractionated stereotactic radiotherapy with cervical sheath protection in the treatment of residual nasopharyngeal carcinoma after radical external irradiation.
Materials and Methods: From August 2006 to August 2010, 36 patients with locally residual nasopharyngeal carcinoma received fractionated stereotactic radiotherapy (FSRT). The median age was 41.3 years (13-76 years), 25 males and 11 females. The remaining tumor sites were limited to nasopharyngeal cavity (52.8%), parapharyngeal space (8.3%), retropharyngeal lymph node (19.4%), parapharyngeal space (13.9%), retropharyngeal lymph node (2.8%) and cavernous sinus (2.8%). The total dose of nasopharyngeal radiotherapy was 69.96-76.90 Gy (median dose 72.58 Gy), including 9 cases of conventional radiotherapy, 27 cases of intensity modulated radiotherapy, and 27 cases of primary radiotherapy. The interval between first-course radiotherapy and FSRT was 12-147 days (median time 39.8 days). The residual tumor volume was 1.46 cm 3-32.98 cm 3 (median volume 14.94 mm 3). FSRT was irradiated with multilobular Grating Rotational conformal radiation. The total dose of FSRT was 10.0-24.0 Gy (median dose 16.5 Gy) and 2.0-5.0 Gy (median dose 16.5 Gy) respectively. The way is 15Gy/3Gy/5f..
Results: The follow-up time was 12-59 months (median time was 34 months). The complete remission rate was 100%. The 3-year local control rate was 100%. The 3-year overall survival rate was 94.4%. The 3-year disease-free survival rate was 77.8%. There was no severe acute radiation reaction. The late complications included 1 case (2.8%) of mild cranial nerve injury in the posterior group, 2 cases (5.6%) of temporal lobe necrosis: no nasopharynx. Massive bleeding or ulceration.
Conclusion: The dose-splitting mode of stereotactic radiotherapy has a significant clinical effect on the residual nasopharyngeal carcinoma after the first-course radiotherapy. FSRT can reduce the nerve and blood vessel injury in the late stage of radiotherapy.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R739.63
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