鼻咽癌全束与半束照射放射性后组颅神经损伤对照研究Ra

1、Authro: Zhang Wei-Jian Subject Code :ADepartment: Department of Radiation Oncology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China Telephone:Email: 鼻咽癌全束与半束照射放射性后组颅神经损伤对照研究Radiation-induced Lower Cranial Nerve Palsy in Nasopharyngeal Carcinoma using Half-beam Ir

2、radiation compared with Whole-beam张纬建 蔡传书 洪金省 陈俊伟 陈秀英 柯春林 黄雄 刘锋（350005 福州，福建医科大学附属第一医院放疗科）【摘要】背景 近年来放射治疗剂量学研究表明，鼻咽癌应用面颈联合野与下颈切线野放射治疗时，与全束照射技术相比，半束照射技术的照射野衔接处剂量重叠区较小，理论上可能降低放射性神经损伤的发生率。为此，作者单位对鼻咽癌全束与半束照射后患者后组颅神经损伤与生存情况进行了相关研究。方法 以作者单位2001年1月至2003年3月188例经病理确诊、并接受首程根治性放射治疗的鼻咽癌患者为研究对象，年龄1577岁（中位年龄46岁），男

3、女比例2.08：1，92福州临床分期、期分别有3、42、64、79例，94.2病例为低分化鳞癌。采用同期非随机对照研究的方法，将患者分为全束（110例）和半束（78例）照射两组。鼻咽部吸收剂量6678Gy（中位吸收剂量72Gy），其中前半程以全束或半束照射方式连接面颈联合野与下颈前切线野，后半程用耳前野-上颈电子线野-下颈前切线野相连接的方法进行照射。两组中均有50病例配合14周期的PF方案（顺铂80mg/m2 d15-Fu 800mg/m2 d13）化疗。用Kaplan-Meier法计算累积发生率，Log-rank时序检验及2检验行单因素分析，Cox比例风险模型、Logistic回归模型做多

4、因素分析。结果 随访终止时间为2008年3月，随访率92.0，中位随访时间54个月（183个月）。全组5年总生存率、无复发生存率、无远处转移生存率、无瘤生存率、分别为68.8、64.9、64.3、60.5，全束组与半束组5年生存率分别为69.3、65.6，差别无统计学意义（P0.353）；多因素分析提示年龄、N分期、临床分期为影响生存的危险因素，性别、T分期、化疗、放疗剂量与生存时间无关。全组后组颅神经损伤15例（7.98），其中全束组10例（9.09），半束组5例（6.41），差别无统计学意义（P0.504）；中位潜伏期35个月（275个月），全束组、半束组分别为37个月（272个月）、32

5、个月（375个月），差别无统计学意义（P0.882）。多因素分析提示，性别、年龄、T分期、N分期、福州分期、化疗、放疗剂量与后组颅神经损伤无关。结论 应用半束放射治疗技术衔接面颈联合野与下颈前切线野治疗鼻咽癌，与全束照射相比，本研究随访期内后组颅神经损伤发生率稍低，但差别尚不显著。【关键词】 鼻咽肿瘤/放射疗法；半束照射；辐射损伤；颅神经麻痹；预后Radiation-induced Lower Cranial Nerve Palsy in Nasopharyngeal Carcinoma with Half-beam IrradiationWei-Jian Zhang Chuan-Shu Ca

6、i, Jin-Sheng Hong, Jun-Wei Chen, Xiu-Ying Chen, Chun-Lin Ke, Xiong Huang, Feng LiuDepartment of Radiation Oncology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China AbstractBACKGROUND. When conventional radiotherapy of nasopharyngeal carcinoma (NPC) is practiced with the facio-n

7、eck field and inferior-neck-supraclavicular field by the half-beam technique, it is confirmed that the dose-overlap region at the match-plane is smaller than the whole-beam technique. So it is believed that half-beam irradiation could reduce the incidence of radiation-induced lower cranial nerve pal

8、sy (RILCNP). This article presents the authors clinical research on this field. METHODS. From Jan 2001 to March 2003, 188 patients with histologically proven NPC were treated and studied retrospectively. Radical radiotherapy was given to this cohort by conventional technique in a total dose of 6678

9、Gy to the primary tumor by 2 Gy per day. There were 110 patients treated with whole-beam irradiation (WB) to a total dose of 36 Gy and 78 with half-beam irradiation (HB), then both of them followed by a smaller facio-neck field and preauricular field. Half of patients in each groups received 14 cycl

10、es cisplatin 80mg/m2 on Day 1 and fluorouracil 800mg/m2on Days 13.Results. The median follow up was 54 months (ranged from 1 to 83 months).The 5-year overall survival rate (OS), relapse-free survival rate (RFS), distant metastasis-free survival rate (DMSF) and disease-free survival rate (DFS) of all

11、 patients were 68.8%, 64.9%, 64.3% and 60.5%, OS of WB group and HB group had no significant effects (69.3% and 65.6%, respectively，P0.353). The incidences of RILCNP and median latency in WB group and HB group were 9.09% and 6.41%, 37 months and 32 months, respectively. Conclusions. The application of the half-beam irradiation for radiotherapy of NPC may reduce the incidence of RILCNP in the long term compared with the w