【作者】 王方正；

【导师】 王连聪；

【作者基本信息】 浙江大学 ， 肿瘤学， 2008， 硕士

【摘要】 目的:探讨肿瘤容积在早期鼻咽癌治疗方案选择的临床意义及其在早期鼻咽癌实施分层治疗的价值。方法:在2005年1月1日至2006年10月31日期间,60例经病理证实初治临床早期鼻咽癌,随机分组为对照组(A组)和治疗组(B组)。所有鼻咽癌患者行CT模拟定位,做CT时均采用增强、薄层扫描,范围是从头顶扫至胸锁关节水平,并体罩固定。由两位(副主任医师以上)肿瘤放疗医师与放射诊断医师一起在每一层面上勾画原发肿瘤范围,利用计算机软件系统计算出大体肿瘤容积(GTV)。A组:单纯常规放射治疗原发灶DT70Gy/35F/7W,双上颈加8Mev或10Mev电子线垂直照射,颈前切线野照射36Gy/18F/3.5W后改用8Mev或10Mev电子线垂直照射,治疗区66～70Gy/33～35F/6.5～7W,预防区50～56 Gy/25～28F/5～5.5W;B组:采用常规分割放射治疗和PF方案同步化疗,放疗第一天开始行同步化疗DDP 30mg/m~2/d,d1-3,5-Fu 0.5g/m~2/d,d1-3,每3周重复一次,总疗程为3周期,常规分割放射治疗方法及剂量同A组。放射损伤程度参考RTOG急性放射损伤评分标准及LENT SOMA评分标准进行分级。结果:所有患者按期完成放疗计划,治疗组中患者完成化疗计划。60例患者均可评价毒副反应及客观疗效。原发灶完全缓解率A组80%,B组96.7%(X~2=4.043,p=0.044),两组差异有统计学意义。急性皮肤反应A组1、2级与3、4级分别为90%、10%和B组分别为80%、20%(X~2=1.176,P=0.278);急性黏膜炎反应A组分别为83.3%、16.7%和B组分别为66.7%、33.3%(X~2=2.222,P=0.136),少见严重的毒副反应。结论:对大体肿瘤容积大于25cm~3的早期鼻咽癌同步放化疗是安全可行的,初步结果显示较好的近期疗效,但有待于进一步结果。其远期并发症如严重张口困难、后组颅神经损伤有待于进一步观察或随访。更多还原

【Abstract】 Objective:To study clinical value of the tumor volume in the modality of choice for treatment of early stage nasopharyngeal carcinoma.Method:From January 1 2005 to October 31 2006,sixty patients with nasopharyngeal carcinoma were proved pathologically and randomized into either the group of radiotherapy alone（control group、A group） or the concurrent chemoradiotherapy （treated group、B group）.Each group consisted of thirty patients.According to the 1992 Fuzhou staging system,all patients had T_1-2N₁M₀.All patients underwent a CT simulation scan with contrast injection on the spiral CT scanner（GE） in the treatment position and immobilization in the radiotherapy department.The scope from the top of the head to below clavicles was scanned at 5-mm increments.The primary tumor volume in nasopharynx was localized on each CT image by more than two radiation oncologist and one radiologist and computed by treatment planning system.The patients in control group received only conventional radiotherapy.The dose of nasopharynx、upper neck、lower neck and superclavicular was 70Gy/35F/7W、66～70Gy/33～35F/6.5～7W、50～56 Gy/25～28F/5～5.5W,respectively.But the patients in treated group received chemoradiotherapy.The concurrent chemotherapy with PF（cisplatin,30mg/m²/d, on Days 1 to 3 and 5-fluorouracil,0.5g/m²/d on Days 1 to 3） was given every three week for three cycles from the first day of radiotherapy.Radiotherapy was administered with the same way in both group.Acute normal tissue effects were graded according to the Radiation Therapy Ontology Group（RTOG） and LENT SOMA radiation morbidity scoring criteria.Results:All patients completed planned doses of radiotherapy and thirty patients in the treatment group completed planned chemotherapy.60 patients were eligible for toxicity and response analysis.After a median follow-up of 16 months,the complete response rates were 96.7%for A group and 80.0%for B group （X²=4.043,P=0.044）,there was a significant difference in complete response in favor of the B group.Acute skin toxicity rates in these two guoups were 90%and 80%in grade 1～2 and 10%and 20%in grade 3～4（X²=1.176,P=0.278）, respectively.Accordingly,the acute mucositis rates were 83.3%and 66.7%in grade 1～2 and 16.7%and 33.3%in grade 3～4（X²=2.222,P=0.136）,respectively. The lack of high-grade toxicity was observed.Conclutions:Chemoradiotherapy was feasible with the gross tumor volume more than 25cm³ for early stage nasopharyngeal carcinoma.Initial results showed good complete response and local control.The remote local control rate and survival rate await further follow-up.The severe late complications also have to be following up.更多还原