摘要
背景与目的:鼻咽癌一侧或双侧颈部淋巴结阴性者颈部的区域预防照射范围及剂量尚无定论。本研究通过回顾性分析,探讨鼻咽癌影像学诊断N0期患者颈部预防野照射方式,并分析颈部淋巴结复发因素及预后因素。方法:收集2002年1月至2004年12月205例N0期鼻咽癌患者资料,治疗前均行鼻咽部和颈部影像学检查。采用直线加速器产生的6～8MV高能X线,以面颈联合野为主的放疗技术,鼻咽原发灶照射剂量为60～80Gy,颈部剂量为46～64Gy。常规分割、连续照射。按颈部预防照射范围将患者分为两组,半颈预防组和全颈预防组。60例进行了化疗。随访时间3～68个月,中位随访时间44个月。累积生存率采用Kaplan-Meier计算,对生存率的差异采用log-rank进行显著性检验,多因素分析采用Cox风险比例模型前进法。结果:205例N0期鼻咽癌患者,3年总生存率及无瘤生存率分别为92.9%、91.9%。半颈、全颈预防组淋巴结复发率分别为2.27%、0,T1、T2、T3、T4期患者的颈部复发率分别为0、3.08%、0、0,鼻咽无复发时、复发时的颈部淋巴结复发率分别为1.03%、0,各组淋巴结复发率比较差异均无统计学意义(P>0.05)。半颈预防组的1年、3年总生存率分别为97.7%、94.2%,全颈预防组1年、3年总生存率分别为97.4%、91.9%(P=0.950);半颈预防组的1年、3年无瘤生存率分别为96.6%、92.9%,全颈预防组1年、3年无瘤生存率分别为95.6%、90.9%(P=0.730)。N0期鼻咽癌预后多因素分析,性别(P=0.039)、T分期(P=0.004)为其独立预后因素。结论:N0期鼻咽癌行半颈预防(Ⅱ、Ⅲ、ⅤA区)应已足够。N0期鼻咽癌颈部淋巴结复发率与咽旁间隙受侵、T分期、鼻咽复发率无关。N0期鼻咽癌的独立预后因素有性别、T分期。
Background and Objective：It is controversial for the irradiation level and dose of the regional prevention for nasopharyngeal cancer （NPC） with one or both cervical lymph node-negative neck.This study was to analyze the prophylactic irradiation of cervical lymph nodes for Stage-N0 NPC patients.Methods：From January 2002 to December 2004,205 patients with NPC,whose negative cervical lymph nodes were diagnosed by imageology,were analyzed retrospectively.CT scan or MRI before treatment was performed to every patients.Six to 8 MV photons and facio-cervical portals were used in radiotherapy.Sixty to 80 Gy had been given to nasopharynx,and 46 to 64 Gy to clinically negative lymph nodes.Consecutive radiotherapy was performed employing conventional fraction of 2 Gy per fraction,once a day and total 5 fractions per week.Chemotherapy was administered to 60 patients.Median follow-up was 44 months.The accumulated survival was calculated according to the Kaplan-Meier method.Log-rank test was used to compare the survival difference.Cox proportional hazards model was used for multivariate analysis.A total of 205 patients with Stage-N0 NPC were divided into the upper-neck group and whole-neck group.Results：The 3-year overall survival rate （OS） was 92.9% and the 3-year disease-free survival rate （DFS） was 91.9% in 205 patients with Stage-N0 NPC.There were 88 patients who had received prophylactic irradiation involved in the upper neck,while the other 117 in the whole neck.The rate of regional failure in the upper-neck group and in the whole-neck group were 2.27% and 0% （P 〉0.05）,respectively.The rates of regional failure in Stages T1,T2,T3,and T4 patients were 0%,3.08%,0%,and 0%（P〉0.05）,respectively.The rates of regional failure in the patients without and with local failure were 1.03% and 0% （P〉0.05）.The 1-year and 3-year OS of upper-neck group were 97.7% and 94.2%,and those of whole-neck group were 97.4% and 91.9% （P=0.950）.The 1-year and 3-year DFS of upper-neck group were 96.6% and 92.9%
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2010年第1期106-110,共5页
Chinese Journal of Cancer
关键词
鼻咽癌/放射疗法
预后
淋巴结
nasopharyngeal carcinoma /radiotherapy prognosis lymph node
