本文選題：鼻咽癌 + 調強適形放療�。� 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：目的:回顧性分析經調強適形放射治療(IMRT)的474例鼻咽癌患者局部或區(qū)域影像學殘留情況,并尋求與之相關聯(lián)的因素,以對影像學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)科大學第一附屬醫(yī)院經病理學證實、接受IMRT、無遠處轉移的初治鼻咽癌患者474例。分析各患者放療結束時影像學殘留情況、殘留部位及殘留消退時間。采用SPSS 19.0統(tǒng)計軟件,Kaplan-Meier方法分析相關因素對預后的影響。組間差異采用Logistic回歸檢驗,多因素分析采用Cox回歸模型�？ǚ綑z驗分析各因素對局部或區(qū)域影像學殘留的影響,多因素采用Logistic回歸分析。P0.05為差異有統(tǒng)計學意義。結果:(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年無復發(fā)生存率(LRFS)為91.77%、82.49%、79.11%,1、3、4年無遠處轉移生存率(DMFS)為91.14%、80.59%、77.63%;行調強適形放療(IMRT)后局部或區(qū)域影像學殘留為47.7%(226/474),其中單純鼻咽原發(fā)灶殘留患者103例,單純頸部淋巴結殘留患者65例,原發(fā)灶及頸部淋巴結均有殘留患者58例。殘留組3個月內消退率17.3%(39/226),3-6內月消退率35.4%(80/226)。放療結束時完全緩解與放療后3個月內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、放療結束時影像學殘留為預后相關因素;口咽、椎前肌、頸動脈鞘區(qū)、翼內肌、翼外肌、顱底、鼻竇、顳下窩、顱內、海綿竇、顱神經侵犯、2010UICC總分期、T分期為影響局部影像學殘留的相關因素,化療、IIa、III、Iva、VIIa區(qū)淋巴結、邊緣強化、壞死為影響淋巴結影像學殘留的相關因素。(3)多因素分析結果顯示年齡50、N分期較晚、放療結束時影像學殘留為預后不良因素,顱底侵犯為影響局部影像學殘留的相關因素,III、VIIa區(qū)淋巴結為影響淋巴結影像學殘留的相關因素,差異均有統(tǒng)計學意義(P0.05)。結論:鼻咽癌患者放療結束時約半數(shù)存在影像學殘留,放療后3個月評價療效是合理的;顱底侵犯可能與放療后局部影像學殘留有關;III、VIIa區(qū)淋巴結可能與淋巴結影像學殘留有關。
[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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.63

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