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)》2017年碩士論文

【摘要】：目的:回顧性分析經(jīng)調(diào)強(qiáng)適形放射治療(IMRT)的474例鼻咽癌患者局部或區(qū)域影像學(xué)殘留情況,并尋求與之相關(guān)聯(lián)的因素,以對(duì)影像學(xué)殘留患者的治療提供參考。方法:回顧性分析2010年1月至2012年12月廣西醫(yī)科大學(xué)第一附屬醫(yī)院經(jīng)病理學(xué)證實(shí)、接受IMRT、無(wú)遠(yuǎn)處轉(zhuǎn)移的初治鼻咽癌患者474例。分析各患者放療結(jié)束時(shí)影像學(xué)殘留情況、殘留部位及殘留消退時(shí)間。采用SPSS 19.0統(tǒng)計(jì)軟件,Kaplan-Meier方法分析相關(guān)因素對(duì)預(yù)后的影響。組間差異采用Logistic回歸檢驗(yàn),多因素分析采用Cox回歸模型�？ǚ綑z驗(yàn)分析各因素對(duì)局部或區(qū)域影像學(xué)殘留的影響,多因素采用Logistic回歸分析。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:(1)2010年1月至2012年12月在我院初治的474例鼻咽癌1、3、4年總生存率(OS)分別為93.04%、85.02%、82.91%,1、3、4年無(wú)復(fù)發(fā)生存率(LRFS)為91.77%、82.49%、79.11%,1、3、4年無(wú)遠(yuǎn)處轉(zhuǎn)移生存率(DMFS)為91.14%、80.59%、77.63%;行調(diào)強(qiáng)適形放療(IMRT)后局部或區(qū)域影像學(xué)殘留為47.7%(226/474),其中單純鼻咽原發(fā)灶殘留患者103例,單純頸部淋巴結(jié)殘留患者65例,原發(fā)灶及頸部淋巴結(jié)均有殘留患者58例。殘留組3個(gè)月內(nèi)消退率17.3%(39/226),3-6內(nèi)月消退率35.4%(80/226)。放療結(jié)束時(shí)完全緩解與放療后3個(gè)月內(nèi)完全緩解患者的生存曲線相近。(2)單因素分析:年齡、2010UICC總分期、T分期、N分期、放療結(jié)束時(shí)影像學(xué)殘留為預(yù)后相關(guān)因素;口咽、椎前肌、頸動(dòng)脈鞘區(qū)、翼內(nèi)肌、翼外肌、顱底、鼻竇、顳下窩、顱內(nèi)、海綿竇、顱神經(jīng)侵犯、2010UICC總分期、T分期為影響局部影像學(xué)殘留的相關(guān)因素,化療、IIa、III、Iva、VIIa區(qū)淋巴結(jié)、邊緣強(qiáng)化、壞死為影響淋巴結(jié)影像學(xué)殘留的相關(guān)因素。(3)多因素分析結(jié)果顯示年齡50、N分期較晚、放療結(jié)束時(shí)影像學(xué)殘留為預(yù)后不良因素,顱底侵犯為影響局部影像學(xué)殘留的相關(guān)因素,III、VIIa區(qū)淋巴結(jié)為影響淋巴結(jié)影像學(xué)殘留的相關(guān)因素,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:鼻咽癌患者放療結(jié)束時(shí)約半數(shù)存在影像學(xué)殘留,放療后3個(gè)月評(píng)價(jià)療效是合理的;顱底侵犯可能與放療后局部影像學(xué)殘留有關(guān);III、VIIa區(qū)淋巴結(jié)可能與淋巴結(jié)影像學(xué)殘留有關(guān)。
[Abstract]:Objective: to retrospectively analyze the local or regional imaging residues in 474 patients with nasopharyngeal carcinoma (NPC) treated by intensity modulated conformal radiotherapy (IMRT). Methods: from January 2010 to December 2012, 474 cases of primary nasopharyngeal carcinoma (NPC) with no distant metastasis confirmed by pathology in the first affiliated Hospital of Guangxi Medical University were analyzed retrospectively. The imaging residue, residual site and residual regression time at the end of radiotherapy were analyzed. Kaplan-Meier method was used to analyze the influence of related factors on prognosis. Logistic regression test and Cox regression model were used for multivariate analysis. Chi-square test was used to analyze the influence of various factors on the local or regional imaging residues. Logistic regression analysis was used to analyze the multiple factors. The difference was statistically significant. Results: (1) from January 2010 to December 2012, the overall survival rate (OS) of 474 patients with nasopharyngeal carcinoma (NPC) in our hospital from January 2010 to December 2012 was 93.04 and 85.02, respectively. The total survival rate (OS) was 93.04 and 85.02, respectively. The 4-year recurrence free survival rate (LRFS) was 91.7772.491.79.1113, and the 4-year non-metastasis survival rate (DMFS) was 91.141480.5977.633.The local or regional shadow after IMRT was performed with strong intensity conformal radiotherapy (IMRT). The imaging residue was 47.7% (226 / 474), including 103 patients with primary nasopharynx residual, There were 65 cases of residual cervical lymph nodes, 58 cases of primary lesions and cervical lymph nodes. The regression rate of residual group within 3 months was 17.3% (39 / 226) and 35.4% (80 / 226) in 3-6 months. The survival curve of patients with complete remission at the end of radiotherapy was similar to that within 3 months after radiotherapy. (2) univariate analysis: age / 2010 UICC total stage / T stage / N stage, imaging residual at the end of radiotherapy was a prognostic factor, oropharynx, prevertebral muscle, oropharynx, prevertebral muscle, Carotid sheath area, medial pterygoid muscle, lateral pterygoid muscle, skull base, paranasal sinus, infratemporal fossa, intracranial, cavernous sinus, cranial nerve invasion of UICC total stage T stage were related factors affecting local imaging residual. (3) the results of multivariate analysis showed that the age of 50 N stage was relatively late, and the imaging residue at the end of radiotherapy was a bad prognostic factor. The invasion of the skull base was the related factor of local imaging residue. The lymph nodes in the IIIV IIa region were the related factors of the imaging residue of lymph nodes, and the differences were statistically significant (P0.05). Conclusion: about half of the patients with nasopharyngeal carcinoma have imaging residues at the end of radiotherapy, and it is reasonable to evaluate the curative effect 3 months after radiotherapy, and the invasion of skull base may be related to the local imaging residue after radiotherapy, and the lymph nodes in the region of VIIa may be related to the residual lymph nodes.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.63

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 謝傳淼,梁碧玲,吳沛宏,鄭列,阮超美,李立,莫運(yùn)仙,鐘銳,陳勇新,林浩皋;螺旋CT與MRI評(píng)價(jià)鼻咽癌顱底侵犯[J];癌癥;2003年07期

2 姚原;吳國(guó)華;夏士安;周仁華;韓增偉;孫紅;;CT/MRI影像融合對(duì)鼻咽癌腫瘤靶區(qū)及三維適形治療影響[J];中國(guó)癌癥雜志;2006年06期

3 鐘鏡聯(lián);梁碧玲;丁忠祥;沈君;黃穗喬;葉瑞心;謝榜昆;孫穎;;應(yīng)用MRI動(dòng)態(tài)增強(qiáng)技術(shù)鑒別鼻咽癌放療后枕骨斜坡纖維化與腫瘤復(fù)發(fā)[J];癌癥;2006年01期

4 白露;李光;陳延治;姚雷;;延長(zhǎng)分次照射時(shí)間對(duì)人鼻咽癌細(xì)胞CNE1放射生物效應(yīng)的影響[J];現(xiàn)代腫瘤醫(yī)學(xué);2009年04期

5 張長(zhǎng)寶;田建明;呂桃珍;左長(zhǎng)京;邵成偉;生晶;;放射性~(125)I粒子組織間植入治療胰腺癌的療效分析[J];介入放射學(xué)雜志;2009年04期

6 熊銳華;田秀榮;王鴻智;鮑忠平;伍靖武;任慶;;CT引導(dǎo)下~(125)I粒子植入治療鼻咽癌根治性放療后鼻咽部病灶殘留[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2011年03期

7 孫健達(dá);李德銳;;鼻咽癌的治療進(jìn)展[J];醫(yī)學(xué)綜述;2010年21期

8 文衛(wèi)平;文譯輝;;內(nèi)鏡外科技術(shù)在鼻及鼻顱底腫瘤治療中的應(yīng)用[J];中國(guó)醫(yī)學(xué)文摘(耳鼻咽喉科學(xué));2010年03期

9 桂巖;陳小婉;張小兵;;甘氨雙唑鈉聯(lián)合放療治療鼻咽癌Meta分析[J];中華腫瘤防治雜志;2014年17期

10 王春華;王蘇美;徐韜;蘇箔金;黃河澄;楊惠玲;;鼻咽癌復(fù)發(fā)的分子標(biāo)志物Jab1和Akt1蛋白表達(dá)的差異[J];中國(guó)病理生理雜志;2014年05期

相關(guān)會(huì)議論文 前1條

1 韓非;王漢渝;黃瑩;鄧美玲;趙充;盧泰祥;;適形調(diào)強(qiáng)放射治療對(duì)鼻咽癌退縮方式的影響[A];第六屆全國(guó)鼻咽癌學(xué)術(shù)大會(huì)論文匯編[C];2010年

相關(guān)博士學(xué)位論文 前1條

1 徐夏;鼻咽癌血漿microRNA分子標(biāo)志物的篩選及意義[D];南方醫(yī)科大學(xué);2014年

相關(guān)碩士學(xué)位論文 前7條

1 徐毅瀧;鼻咽癌放療后頸部淋巴結(jié)殘留或復(fù)發(fā)的預(yù)后分析[D];福建醫(yī)科大學(xué);2015年

2 趙婷婷;基于調(diào)強(qiáng)放射治療和RTOG頸部淋巴結(jié)分區(qū)標(biāo)準(zhǔn)的鼻咽癌N分期的研究[D];廣西醫(yī)科大學(xué);2015年

3 梁潔;49例鼻咽癌調(diào)強(qiáng)放療后復(fù)發(fā)的臨床分析[D];廣西醫(yī)科大學(xué);2015年

4 陳琛;模擬不同照射模式對(duì)鼻咽癌細(xì)胞系CNE2放射生物學(xué)效應(yīng)的影響[D];南華大學(xué);2015年

5 黃少華;不同病理類型鼻咽癌臨床表現(xiàn)和預(yù)后分析[D];福建醫(yī)科大學(xué);2014年

6 覃金昌;鼻咽癌放療后局部復(fù)發(fā)或殘留病變鼻內(nèi)鏡手術(shù)治療近期療效[D];廣西醫(yī)科大學(xué);2014年

7 趙雅潔;中晚期鼻咽癌調(diào)強(qiáng)適形放療結(jié)束時(shí)局部或區(qū)域影像學(xué)殘留患者預(yù)后分析[D];中南大學(xué);2014年

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