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目的 观察后程加速超分割治疗鼻咽癌的远期疗效及毒副反应。方法 136例鼻咽癌患者分为后程加速超分割 (LCAF)治疗组和常规分割 (CF)治疗组 ,其中LCAF组 6 6例 ,先用常规分割照射 36～ 4 0Gy ,18～ 2 0分次 ,2 4～ 2 8d完成 ,再用LCAF照射 35 .1～ 4 0 .5Gy,2 6～ 30分次 ,17～ 2 1d ,2次/d ,1.35Gy/次 ,间隔 6h以上 ,总量 75 .1～ 76 .5Gy ,4 6～ 4 8分次 ,4 5～ 4 7d完成。CF组 70例 ,总量 70Gy,35分次 ,4 7～ 4 9d完成。结果 鼻咽部肿瘤完全缓解率 (CR)LCAF组和CF组分别为 97%、90 % ;1、3、5年肿瘤局部控制率LCAF组分别为 97.0 %、95 .4 %、89.8% ,CF组分别为 92 .8%、77.1%、70 .1% ,2个组差异有显著性意义 (χ2 =7.0 6 ,P <0 .0 1)。 1、3、5年的生存率LCAF组分别为 98.5 %、77.3%、6 8.2 % ,CF组分别为 95 .7%、72 .7%、5 9.6 % ,2个组差异无显著性意义 (χ2 =0 .81,P >0 .0 5 )。2个组放射治疗急性毒副反应 ,LCAF组口腔黏膜反应与CF组差异无显著性意义 (χ2 =0 .5 0 ,P >0 .0 5 )。 2个组远期毒副反应差异也无显著性意义 (χ2 =0 .0 7,P >0 .0 5 )。结论 鼻咽癌LCAF的局部控制率明显高于CF的 ,但长期生存率无差别 ,患者能耐受LCAF治疗 ,不增加远期毒副反应。
Objective To observe the long-term effect and toxicity of late-course accelerated hyperfractionation in the treatment of nasopharyngeal carcinoma. Methods One hundred and sixty-six patients with nasopharyngeal carcinoma were divided into two groups: LCAF group and CF group. In LCAF group, 66 patients were initially irradiated with 36 ~ 40 Gy and 18 ~ 20 Times, 14 ~ 28 days, then LCAF irradiation was 35.1 ~ 40.5Gy, 26 ~ 30 times, 17 ~ 21d, 2 times / d, 1.35Gy / time, the interval more than 6h, the total 75 .1 ~ 76 .5Gy, 4-6 ~ 48 times, 4 ~ 4 ~ 4d complete. CF group 70 cases, the total 70Gy, 35 times, 47 ~ 49d completed. Results The complete response rate (CR) of nasopharyngeal tumor was 97% and 90% in LCAF group and CF group respectively. The local control rates of LCAF group at 1, 3 and 5 years were 97.0%, 95.4% and 89.8%, respectively The difference was statistically significant (χ2 = 7.06, P <0.01) in the two groups, which were 92.8%, 77.1% and 70.1% respectively. The survival rates at 1, 3 and 5 years were 98.5%, 77.3% and 62.2% in the LCAF group and 95.7%, 72.7% and 59.6% in the CF group, respectively. There was no significant difference between the two groups χ2 = 0.81, P> 0.05). There were no significant differences between two groups in radiotherapy of acute toxicities and side effects (χ2 = 0.05, P> 0.05). There was no significant difference in long-term toxicities between the two groups (χ2 = 0.07, P> 0.05). Conclusion The local control rate of LCAF in nasopharyngeal carcinoma was significantly higher than that of CF, but the long-term survival rate was no difference. Patients were able to tolerate LCAF without increasing long-term toxicity.