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目的:回顾性分析头颈部肿瘤调强放疗(IMRT)的长期随访结果和影响预后的因素。方法:136例初治头颈部肿瘤接受全程IMRT,48例(35.3%)联合化疗。手术联合放疗平均剂量62.14 Gy(50～73 Gy),根治性放疗平均剂量68.99 Gy(56.4～77 Gy)。结果:中位随访时间19个月,3年局控率、区域控制率、无远处转移生存率、无瘤生存率和总生存率分别为83.2%、93.2%、75.8%、66.4%、67.6%。多因素分析显示临床分期、治疗模式、放疗前有无贫血是影响患者生存率的独立预后因素。急性0、1、2、3级皮肤反应发生率分别为3.7%,71.3%,24.3%,0.7%;0、1、2、3、4级黏膜反应发生率分别为4.4%,22.8%,57.4%,14.7%,0.7%。治疗结束1年后1、2、3度口干发生率分别为21.3%、16.2%、0.7%。结论:IMRT联合手术和化疗治疗头颈部肿瘤可取得较好疗效,不良反应可以耐受。临床分期、治疗模式、放疗前有无贫血是影响生存的主要因素。
OBJECTIVE: To retrospectively analyze the long-term follow-up results of head-and-neck tumor IMRT and the prognostic factors. Methods: Thirty-six patients with newly diagnosed head and neck tumors underwent full IMRT and 48 patients (35.3%) combined with chemotherapy. The average dose of surgery combined with radiotherapy was 62.14 Gy (50-73 Gy) and the average dose of radical radiotherapy was 68.99 Gy (56.4-77 Gy). Results: The median follow-up time was 19 months. The three-year local control rate, regional control rate, distant metastasis-free survival rate, tumor-free survival rate and overall survival rate were 83.2%, 93.2%, 75.8%, 66.4%, 67.6 %. Multivariate analysis showed that clinical stage, treatment mode, whether or not anemia before radiotherapy is an independent prognostic factor affecting the survival rate of patients. The incidences of acute grade 0, 1, 2, 3 skin reactions were 3.7%, 71.3%, 24.3%, 0.7% respectively; the incidences of mucosal reactions of grade 0, 1, 2, 3, and 4 were 4.4%, 22.8%, 57.4 %, 14.7%, 0.7%. One year after the end of treatment, the incidence of dry mouth at 1, 2 and 3 degrees was 21.3%, 16.2% and 0.7%, respectively. Conclusion: IMRT combined with surgery and chemotherapy for head and neck cancer can achieve better results, and adverse reactions can be tolerated. Clinical staging, treatment mode, with or without anemia before radiotherapy is the main factor affecting survival.