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N0期鼻咽癌颈部可疑阳性淋巴结放疗剂量的探讨

石宇, 王仁生, 吕君, 张婷婷, 许卓华

石宇, 王仁生, 吕君, 张婷婷, 许卓华. N0期鼻咽癌颈部可疑阳性淋巴结放疗剂量的探讨[J]. 肿瘤防治研究, 2013, 40(06): 608-612. DOI: 10.3971/j.issn.1000-8578.2013.06.025
引用本文: 石宇, 王仁生, 吕君, 张婷婷, 许卓华. N0期鼻咽癌颈部可疑阳性淋巴结放疗剂量的探讨[J]. 肿瘤防治研究, 2013, 40(06): 608-612. DOI: 10.3971/j.issn.1000-8578.2013.06.025
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SHI Yu, WANG Rensheng, LV Jun, ZHANG Tingting, XU Zhuohua. Research of Radiotherapy Dose on Suspicious Positive Lymph Nodes in Neck Negative Nasopharygneal Carcinoma Patients[J]. Cancer Research on Prevention and Treatment, 2013, 40(06): 608-612. DOI: 10.3971/j.issn.1000-8578.2013.06.025
Citation: SHI Yu, WANG Rensheng, LV Jun, ZHANG Tingting, XU Zhuohua. Research of Radiotherapy Dose on Suspicious Positive Lymph Nodes in Neck Negative Nasopharygneal Carcinoma Patients[J]. Cancer Research on Prevention and Treatment, 2013, 40(06): 608-612. DOI: 10.3971/j.issn.1000-8578.2013.06.025
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N0期鼻咽癌颈部可疑阳性淋巴结放疗剂量的探讨

  • 530021 南宁，广西医科大学第一附属医院放疗科

详细信息
    作者简介:

    石宇（1986-），男，硕士在读，主要从事恶性肿瘤的临床研究

    通讯作者:

    王仁生，E-mail：wrsgx@yahoo.com.cn

  • 中图分类号: R739.63

Research of Radiotherapy Dose on Suspicious Positive Lymph Nodes in Neck Negative Nasopharygneal Carcinoma Patients

  • 1.Department of Radiotherapy,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China

摘要

    摘要
  • 摘要: 目的 观察N0期鼻咽癌患者颈部可疑阳性淋巴结（最大横断面短径≥0.5 cm但＜1 cm、包膜完整、无中央坏死）放疗剂量为64 Gy时淋巴结的消退情况、有无局部复发，以及患者的不良反应及预后。方法 回顾性分析2008年1月—2011年1月我院80例有颈部可疑阳性淋巴结的N0期鼻咽癌患者，按中国鼻咽癌2008年分期标准，T1期4例，T2期15例，T3期36例，T4期25例。所有患者均采用调强放疗，其中T1、T2患者采用单纯放疗，T3、T4患者配合单药铂类方案同步化疗。鼻咽大体肿瘤体积 （GTVnx）处方剂量70~74 Gy，颈部未达标可疑阳性淋巴结（GTVnd可疑阳性）处方剂量64 Gy，临床靶体积1（CTV1）处方剂量60~64 Gy，临床靶体积2（CTV2）处方剂量50~54 Gy，分30次进行照射，照射时间6周。采用配对t检验比较放疗前后淋巴结的消退有无统计学意义。结果 随访率为98.8%。80例患者129个淋巴结，放疗后颈部可疑阳性淋巴结CR 117个，PR 6个，NC 6个，有效率95.3%。放疗前后淋巴结消退有意义（P<0.05)。4年局部控制率、无远处转移率、总生存率分别为94.6%、95.9%、93.7%。有4例GTVnx内复发，3例出现远处转移。颈部放射性皮肤反应1、2级分别占77.5%、22.5%。颈部纤维化1级占15%。结论 64 Gy的放疗剂量是鼻咽癌颈部可疑阳性淋巴结转移很好的控制剂量，且不良反应较轻，患者可耐受。

     

    Abstract: Objective To investigate the regression of lymph nodes, local recurrence, adverse effects and prognosis in neck negative nasopharygneal carcinoma(NPC) patients with uspicious positive lymph nodes (0.5 cm≤maximum diameter＜1 cm，intact capsule,no central necrosis) treated by 64Gy radiation doses. Methods From Jan 2008 to Jan 2011,80 NPC patients with N0 stage who had suspicious positive lymph nodes were studied retrospectively. According to the 2008 staging system, there were 4 patients in stage T1,15 in stage T2,36 in stage T3 and 25 patients in stage T4.All patients were irradiated by IMRT technique. Patients in T1 and T2 were treated by IMRT alone while patients in T3 and T4 by concurrent chemotherapy. The prescription does was(70-74)Gy/30f to the nasopharynx gross tumor volume (GTVnx),64Gy/30f to suspicious positive neck lymph nodes(GTVndsuspicious positive),(60-64)Gy/30f to the first clinical target volume(CTV1) and (50-54)Gy/30f to the second clinical target volume (CTV2).The irradiation time was 6 weeks. Paired T test was used to compare the regression of lymph nodes before and after radiation. Results The follow-up rate was 98.8%. 80 patients had 129 lymph nodes. 117 lymph nodes was CR，6 was PR and NC was 6.Partial response rate was 95.3%.The regression of lymph nodes had statistical differences (P＜0.05) between before and after radiation.The 4-year local-regional control rates, distant metastasis-free survival rate and overall survival rate were 94.6%，95.9% and 93.7%. 4 patients had recurrent events in GTVnx and 3 patients had distant metastasis. The neck skin reaction with grade 1 and 2 was 77.5% and 22.5% respectively. Neck skin radiation fibrosis with grade 1 was 15%. Conclusion The 64Gy radiation dose was the appropriate control dose on suspicious positive lymph nodes in neck negative nasopharygneal carcinoma patients with a acceptable adverse effect.

     

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  • [1] Feinmesser R，Freeman J L，Feinmesser M，et al.Role of modern imaging in decision-making for elective neck dissection[J].Head Neck，1992,14（3）：173-6.
    [2] Tang ZY. Modern Oncology[M].Second Edition.Shanghai:Shanghai Medica University Press，2000:627-57.[ 汤钊猷.现代肿瘤学[M]. 第2版.上海：上海医科大学出版社，2000:627-57.]
    [3] Hong RL,Ting LL,Ko JY,et al.Induction chemotherapy with    mitomycin,epirubicin,cisplatin,fluorouracil,and leucovorin followed by radiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma[J].J  Clin Oncol,2001,19(23):4305-13.
    [4] Radiation Therapy Oncology Group Protocol 02-25[EB/OL]. [2012-03- 20].http://www.rtog.org/members/protocols/0225/0225.pdf.
    [5] Kuang WL,Zhou Q,Shen LF.Outcomes and prognostic factors of conformal radiotherapy versus intensety -modulated radiotherapy for nasopharyngeal carcinoma[J].Clin Transl Oncol,2012,14(10):783-90.
    [6] Zhao C,Xiao WW,Han F,et al. Long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy[J]. Zhognhua Fang She Zhong Liu Xue Za Zhi， 2010,19(3):191-6.[赵充，肖巍魏，韩非，等.419例鼻咽癌患者调强放疗疗效和影响[J]. 中华放射肿瘤学杂志， 2010,19(3):191-6.]
    [7] Gao YS，Hu CS，Ying HM,et al.Treatment results of    nasopharyngeal carcinoma : a retrospective analy- sis of 1837 cases in a single institute[J]. Zhognhua Fang She Zhong Liu Xue Za Zhi，2008,17（5 ）：335-9.[高云生，胡超苏，应红梅，等.1837例鼻咽癌疗效的回顾性分析[J].中华放射肿瘤学杂志，2008,17（5） ：335-9.]
    [8] Pan JJ，Zhang Y，Lin SJ,et al.Long-term results of nasopharyngeal carcinoma treated with radiothe- rapy:1706 cases report[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi，2008,17（4）：247-51.[潘建基，张瑜 ，林少俊，等.1706例鼻咽癌放疗远期疗效分析[J].中华放射肿瘤学杂志，2008,17（4）：247-51.]
    [9] Sham JS,Choy D,Wei WI.Nasopharyngeal carcinoma: orderly neck node spread[J].Int J Radiat Oncol Biol Phys,1990,19(4):929-33.
    [10] Xiang SJ，Huang YD，Huang JY,et al. Salvage surgery  for patients with residual cervical lymph node of nasopharyngeal carcinoma after radical radiotherapy[J].Zhonguo Er Bi Yan Hou Tou Jing Wai Ke,2006,13(9）:615-7.[项松洁，黄益灯，黄加云，等.鼻咽癌根治性放疗后颈淋巴结残留的手术治疗[J].中国耳鼻 咽喉头颈外科，2006,13（9）: 615-7.]
    [11] Chen SY,Li XM,Li EZ,et al. The risk factors of cervical lymph node recurrence after radiotherapy for neck negative nasophargneal carcinoma[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2001,10（1）:4- 6.[陈善义，李先明，李而周，等.影响N0期鼻咽癌放射治疗后颈淋巴结复发因素分析[J].中华放射肿瘤学杂志， 2001,10（1）:4-6.]
    [12] Ma DY,Wang RS,Qi GZ,et al. Logistic regression analysis of the Factors Influencing Residual Cervical Lymphatic Metastasis in NPC after Radiotherapy [J].Zhongguo Zhong Liu Lin Chuang，2007,34 （5):278-81.[马代元，王仁生，漆光子，等.鼻咽癌颈部转移淋巴结放疗后残留影响因素的Logistic回归分析[J].中 国肿瘤临床，2007,34（5):278-81.]
    [13] Gu XZ,Yin WB,Liu TF,et al.Radiation Oncology[M].First Edition. Peking:Chinese Academy of Medical Sciences& Peking Union Medical College Press，1993：467．[谷铣之，殷蔚伯，刘泰福，等.肿瘤放射治疗学[M]. 第1版.北京：北京医科大学中国协和医科大学联合出版社，1993：467．]
    [14] Tang L,Mao Y,Liu L,et al.The volume to be irradiated during selective neck irradiation in nasopharyngeal carcinoma:analysis of the spread patterns in lymph nodes by magnetic resonance imaging[J].Cancer,2009,115(3):680-8.
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出版历程
  • 收稿日期:  2012-11-25
  • 修回日期:  2013-01-31
  • 刊出日期:  2013-06-24

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