鼻咽癌全束與半束照射放射性后組顱神經(jīng)損傷對(duì)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:13809511120 Email: ZWJ9090鼻咽癌全束與半束照射放射性后組顱神經(jīng)損傷對(duì)照研究Radiation-induced Lower Cranial Nerve Palsy in Nasopharyngeal Carcinoma

2、 using Half-beam Irradiation compared with Whole-beam張緯建 蔡傳書(shū) 洪金省 陳俊偉 陳秀英 柯春林 黃雄 劉鋒（350005 福州，福建醫(yī)科大學(xué)附屬第一醫(yī)院放療科）【摘要】背景 近年來(lái)放射治療劑量學(xué)研究表明，鼻咽癌應(yīng)用面頸聯(lián)合野與下頸切線野放射治療時(shí)，與全束照射技術(shù)相比，半束照射技術(shù)的照射野銜接處劑量重疊區(qū)較小，理論上可能降低放射性神經(jīng)損傷的發(fā)生率。為此，作者單位對(duì)鼻咽癌全束與半束照射后患者后組顱神經(jīng)損傷與生存情況進(jìn)行了相關(guān)研究。方法 以作者單位2001年1月至2003年3月188例經(jīng)病理確診、并接受首程根治性放射治療的鼻咽癌患者為研究對(duì)象

3、，年齡1577歲（中位年齡46歲），男女比例2.08：1，92福州臨床分期、期分別有3、42、64、79例，94.2病例為低分化鱗癌。采用同期非隨機(jī)對(duì)照研究的方法，將患者分為全束（110例）和半束（78例）照射兩組。鼻咽部吸收劑量6678Gy（中位吸收劑量72Gy），其中前半程以全束或半束照射方式連接面頸聯(lián)合野與下頸前切線野，后半程用耳前野-上頸電子線野-下頸前切線野相連接的方法進(jìn)行照射。兩組中均有50病例配合14周期的PF方案（順鉑80mg/m2 d15-Fu 800mg/m2 d13）化療。用Kaplan-Meier法計(jì)算累積發(fā)生率，Log-rank時(shí)序檢驗(yàn)及2檢驗(yàn)行單因素分析，Cox比例

4、風(fēng)險(xiǎn)模型、Logistic回歸模型做多因素分析。結(jié)果 隨訪終止時(shí)間為2008年3月，隨訪率92.0，中位隨訪時(shí)間54個(gè)月（183個(gè)月）。全組5年總生存率、無(wú)復(fù)發(fā)生存率、無(wú)遠(yuǎn)處轉(zhuǎn)移生存率、無(wú)瘤生存率、分別為68.8、64.9、64.3、60.5，全束組與半束組5年生存率分別為69.3、65.6，差別無(wú)統(tǒng)計(jì)學(xué)意義（P0.353）；多因素分析提示年齡、N分期、臨床分期為影響生存的危險(xiǎn)因素，性別、T分期、化療、放療劑量與生存時(shí)間無(wú)關(guān)。全組后組顱神經(jīng)損傷15例（7.98），其中全束組10例（9.09），半束組5例（6.41），差別無(wú)統(tǒng)計(jì)學(xué)意義（P0.504）；中位潛伏期35個(gè)月（275個(gè)月），全束組、半

5、束組分別為37個(gè)月（272個(gè)月）、32個(gè)月（375個(gè)月），差別無(wú)統(tǒng)計(jì)學(xué)意義（P0.882）。多因素分析提示，性別、年齡、T分期、N分期、福州分期、化療、放療劑量與后組顱神經(jīng)損傷無(wú)關(guān)。結(jié)論 應(yīng)用半束放射治療技術(shù)銜接面頸聯(lián)合野與下頸前切線野治療鼻咽癌，與全束照射相比，本研究隨訪期內(nèi)后組顱神經(jīng)損傷發(fā)生率稍低，但差別尚不顯著?！娟P(guān)鍵詞】 鼻咽腫瘤/放射療法；半束照射；輻射損傷；顱神經(jīng)麻痹；預(yù)后Radiation-induced Lower Cranial Nerve Palsy in Nasopharyngeal Carcinoma with Half-beam IrradiationWei-Jian

6、 Zhang Chuan-Shu Cai, 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 practic

7、ed with the facio-neck 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 lowe

8、r cranial nerve palsy (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

9、total dose of 6678 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 grou

10、ps received 14 cycles 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 surviva

11、l rate (DFS) of all 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