摘要
目的总结分析经治的105例斜坡受侵鼻咽癌患者的临床资料,探讨放宽脑干限量的安全性和有效性。方法收集该院2011年1月至2012年12月收治的、有3年以上长期随访资料的105例斜坡受侵鼻咽癌患者的临床资料,统计受侵斜坡和脑干剂量,并进行脑干放射性损伤评价和生存分析。结果 105例患者均为T3、T4期,随访36~65个月,中位45个月。3年局部无复发生存率、区域无复发生存率、疾病无进展生存率、无远处转移生存率、总生存率分别为92.9%、95.9%、77.0%、86.3%、88.6%。105例患者中脑干最大值(Dmax)超过54.00 Gy 71例(67.6%),超过60.00 Gy 26例(24.8%),其中80.0%在66.00 Gy以下。另对105例中的77例患者进行了脑干外放边界1 mm后1.0%体积剂量(D01)分析,外放边界1 mm后D01>60.00 Gy 9例(11.7%)。105例患者在随访期间均未出现脑干损伤症状,核磁检查也未提示脑干异常改变。受侵斜坡累积剂量61.67~81.68 Gy,中位72.77 Gy。受侵斜坡剂量是局部无复发生存与总生存的独立预后因素。结论在单次分割剂量不超过2.00 Gy情况下,将绝对脑干Dmax放宽到66.00 Gy,严格控制外放边界1 mm后D01在63.00 Gy以下是安全的,并有利于提高局部晚期鼻咽癌患者的生存率。
Objective To analyze the clinical data of 105 patients diagnosed with nasopharyngeal carcinoma invading clivus and to explore the safety and effectiveness of modified dose constrain on brainstem. Methods A total of 105 patients who were diagnosed with nasopharyngeal carcinoma invading clivus and followed up more than 3 years in the hospital from January2011 to December 2012 were selected. The dose of invaded clivus and brainstem were analyzed,as well as the radiation injury of brainstem and survival time. Results All the 105 cases were T3 and T4 stage. The median follow-up time was 45 months（36~65months）. The 3-year local relapse-free survival,regional relapse-free survival,disease free survival,distant metastasis free survival and overall survival were 92.9%,95.9%,77.0%,86.3% and 88.6%,respectively. Among 105 patients,71 cases（67.6%） have maximum dose（Dmax） on absolute brainstem over 54.00 Gy,26 cases（24.8%） have Dmax over 60.00 Gy,whereas 80% of them were below 66.00 Gy. Furthermore,1% brainstem volume dose（D01） of the planning organ at risk volume（PRV） were analyzed for 77 out of 105 cases and 9 cases（11.7%） D0160.00 Gy when PRV was 1 mm extended. None of the enrolled 105 patients developed brainstem-associated symptoms and no magnetic resonance imaging（MRI） abnormality of brainstem was found during the follow-up period. The median dose of involved clivus was 72.77 Gy（61.27~81.68 Gy）. The dose of involved clivus was proved to be an independent prognostic factor for both local relapse-free survival and overall survival. Conclusion Dmax of absolute brainstem can be as high as 66.00 Gy in the condition of single fraction size of brainstem less than 2.00 Gy;D01 of PRV 1 mm should be strictly controlled under 63.00 Gy,which might help to increase the survival rate of local advanced nasopharyngeal carcinoma.
出处
《现代医药卫生》
2017年第16期2420-2424,共5页
Journal of Modern Medicine & Health
基金
四川省科技厅科技支撑项目(JH2015001)
关键词
鼻咽肿瘤
颅窝
后
脑干
随访研究
Nasopharyngeal neoplasms
Cranial fossa
posterior
Brain stem
Follow-up studies
