摘要
目的 评价分析鼻咽癌颅底骨质破坏在首程放射治疗后远期疗效及预后因素。方法1985～ 1986年 10 0例经病理证实为鼻咽癌 ,均为鳞状细胞癌 ,其中低分化 96例 ,高分化 4例。所有病例经CT扫描证实颅底骨质被破坏 ,胸部X线摄片及腹部B型超声检查未见异常。采用60 Co或直加单纯外照射 ,总剂量 6 6～ 80Gy/ 6～ 8周 ,2Gy/次。所有患者均定期随访 ,平均随访 2 2 3个月 (2～ 174个月 )。采用Kaplan Meier统计生存率 ,Cox模型分析各种预后因素 ,包括侵犯海绵窦、蝶窦、筛窦、上颌窦 ,咽旁间隙侵犯、头痛、颅神经损害 ,治疗后头痛缓解及颅神经损害的修复等。结果 1、3、5、10年生存率分别为 78 8%、38 0 %、2 6 9%、13 0 % ,但伴有前组颅神经 (Ⅰ～Ⅷ )和后组颅神经 (Ⅸ～Ⅻ )同时侵犯者 5年生存率仅为 7 7%。死亡原因包括局部复发 5 9例 ,远处转移 2 1例 ,局部复发加远处转移 1例 ,非肿瘤原因死亡 5例。经多因素分析 :影响预后的独立因素为颅神经损害、放射治疗后颅神经修复及头痛缓解。结论 鼻咽癌颅底骨质侵犯患者的长期随访结果分析 ,发现颅神经损害、放射治疗后颅神经修复及头痛症状的缓解对预后有重要意义。
Objective To evaluate the long term outcome and prognostic factors in patients with skull base erosion from nasopharyngeal carcinoma (NPC) after initial radiation therapy Methods From January 1985 to December 1986, 100 patients (71 male, 29 female) with the diagnosis of NPC were found to have skull base erosion from computed tomography (CT) The mean age was 41 (16 66) years Ninety six patients had World Health Organization (WHO) type III undifferentiated carcinoma while four had type I carcinomas Metastatic work up including chest radiography, liver ultrasound and liver function test were negative All patients underwent external beam radiotherapy alone to 66 80Gy over 6 8 weeks Daily fraction size of 2Gy was delivered utilizing cobalt 60 or linear accelerator No patient received chemotherapy All patients were followed up at regular intervals after irradiation Median follow up was 22 3 months (2 months 174 months) Overall survival of the cohort was computed by the Kaplan Meier method Potential prognostic factors on survival were examined Multivariate analyses was performed using Cox regression model Results One, three, five, and ten year overall survival rates for the cohort were 79%, 38%, 27% and 13%, respectively However, in the sub group of patients with both anterior cranial nerves (I VIII) and posterior cranial nerve (IX XII) involvement had a five year survival of only 7 7% Causes of death included local recurrence (59 patients), distant metastases (21 patients), both local recurrence and distant metastases (1 patient) and unrelated causes (5 patients) After multivariate analysis, complete recovery of cranial nerve involvement, cranial nerves palsy and recovery of headache after irradiation were found to be independent prognostic factors in this cohort Conclusion This report presents one of the longest follow ups of patients with nasopharyngeal carcinoma invading skull base It demonstrates the importance of cranial nerves involvement as well as r
出处
《中华耳鼻咽喉科杂志》
CSCD
北大核心
2001年第6期463-467,共5页
Chinese Journal of Otorhinolaryngology
关键词
鼻咽肿瘤
鳞状细胞癌
放射疗法
存活率
颅底骨质破坏
颅神经损伤
Nasopharyngeal neoplasms
Carcinoma,squamous cell
Radiotherapy
Skull base neoplasms
Prognosis
Survival rate
