N_0期鼻咽癌颈部照射的合适范围探讨

Appropriate Extent for Elective Irradiation to the Neck of N_0 Nasopharyngeal Cancer Patients

摘要: 目的　确定N0 期鼻咽癌颈部照射的合适范围。方法　回顾性分析 196例N0 期鼻咽癌病人治疗后颈部控制结果及相关因素。全部病例接受单纯根治性放疗, 鼻咽中位剂量DT70Gy ;颈部治疗范围只包括双侧上半颈, 治疗剂量DT( 4 0～ 72 )Gy(平均DT4 7Gy, 中位DT5 0GY)。结果　共有 9例病人治疗后发生颈部淋巴结转移, 颈部 5年控制率 96 .1%。其中 4例同时合并鼻咽部复发, 单纯颈部复发 5例, 单纯颈部复发率 2 .5 5 % ( 5 / 196 )。颈部治疗剂量低于DT4 5Gy组的颈部复发率为9.0 % ( 6 / 6 7)明显高于剂量高于DT4 5Gy组的2 .3% ( 3/ 12 9) ;有鼻咽复发者的颈部复发率 13.3% ( 4 / 33)明显高于无复发者的 3.0 % ( 5 / 16 6 ) ;以上差异有统计学意义。结论　N0 期鼻咽癌病人放射治疗后颈部复发率很低, 颈部治疗范围包括双上颈已足够, 治疗剂量应高于 4 5Gy。

Abstract: Objective To justify the elective irradiation volume of the neck in N 0 nasopharyngeal cancer (NPC) patients. Methods One hundred and ninety six NPC patients without overt neck node metastases were retrospectively analyzed. All patients were treated with radiotherapy alone and followed up beyond 5 years. The extent of elective neck irradiation defined at upper half of the neck. Median radiation doses were 70Gy in the primary tumors and 50Gy (40～72)Gy in the upper necks. Results Nine out 196 patients wer...