鼻咽癌IMRT放射性溃疡临床及剂量因素分析

doi:10.3760/cma.j.issn.1004-4221.2016.05.004

摘要
图/表
参考文献()
相关文章 (12)
点击分布统计
下载分布统计

全文: PDF (419 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的通过分析鼻咽癌初程IMRT后发生鼻咽溃疡的临床特点、预后及放疗剂量学等资料,了解与放射性鼻咽溃疡发生的相关因素。方法回顾分析2001—2013年接受初程IMRT的鼻咽癌患者共1217例,结合临床症状、腔镜、MRI及病理(除外局部复发)诊断放射性鼻咽溃疡共21例,总结其临床特点、预后情况,并复阅其放疗计划进行剂量学评估。结果 21例放射性溃疡患者中男17例、女4例;T₂期1例、T₃期3例、T₄期17例。GTV_nx中位数83 cm³,除1例T₂期病变PGTV_nx处方剂量为69.96 Gy外,余20例处方剂量为73.92 Gy。鼻咽溃疡发生时间为放疗结束后1.8~21.9个月(中位数6.2个月),鼻咽部大出血发生率为48%(10/21)。21例患者中6例溃疡愈合,15例持续不愈,其中8例死亡(鼻咽大出血4例、恶液质及伴多器官功能衰竭3例、多发骨转移1例)。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	尹珍珍
	高黎
	罗京伟
	易俊林
	黄晓东
	王凯
	曲媛
	张世平
	李素艳
	肖建平
	徐国镇

关键词 ：鼻咽肿瘤/三维放射疗法, 放射性鼻咽坏死, 因素分析

Abstract： Objective To investigate the influencing factors for postradiation nasopharyngeal necrosis (PRNN) by analyzing clinical characteristics, prognosis, and dosimetry of PRNN after initial intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods A retrospective analysis was performed among 1217 patients with NPC who received initial IMRT from 2001 to 2013. Twenty-one patients were diagnosed with PRNN by clinical symptoms, endoscopy, magnetic resonance imaging, and pathological evidence (not including local recurrence). The clinical characteristics and prognosis were summarized and the radiotherapy plans were reassessed for dosimetric evaluation. Results In the 21 patients with PRNN, 17 were male and 4 female;one patient was in stage T₂, 3 in stage T₃, and 17 in stage T₄. The median volume of gross tumor was 83 cm³. All patients received radiotherapy with a prescribed dose of 73.92 Gy except one patient with stage T₂ disease who received a prescribed dose of 69.96 Gy. The time to PRNN after radiotherapy ranged between 1.8 and 21.9 months (median time=6.2 months). The incidence of massive nasopharyngeal bleeding was 48%(10/21). In the 21 patients, 6 recovered form PRNN, 15 remained ill, and 8 patients died, consisting of 4 who died of massive nasopharyngeal bleeding, 3 of cachexia with multiple organ failure, and 1 of multiple bone metastases. Conclusions PRNN is one of the severe adverse reactions after IMRT for NPC. The development of PRNN is related to advanced T stage, large tumor volume, poor nutritional status, infection, radiotherapy dose, and intense treatment. Massive nasopharyngeal bleeding and cachexia are the primary causes of death in patients with PRNN.

Key words： Nasopharyngeal neoplasms/three-dimensional radiotherapy Radiation nasopharyngeal necrosis Factor analysis

收稿日期: 2015-04-16

通讯作者: 高黎,Email:li_gao2008@outlook.com

引用本文:

尹珍珍,高黎,罗京伟等. 鼻咽癌IMRT放射性溃疡临床及剂量因素分析[J]. 中华放射肿瘤学杂志, 2016, 25(5): 438-442.

Yin Zhenzhen,Gao Li,Luo Jingwei et al. An analysis of clinical and dosimetric factors for postradiation nasopharyngeal necrosis in intensity-modulated radiotherapy for nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2016, 25(5): 438-442.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2016.05.004 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2016/V25/I5/438

[1]易俊林,高黎,黄晓东,等.416例鼻咽癌IMRT远期生存与影响因素分析[J].中华放射肿瘤学杂志,2012,21(3):196-200.DOI:10.3760/cma.j.issn.1004-4221.2012.03.002.
Yi JL,Gao L,Huang XD,et al. Nasopharyngeal carcinoma treated by intensity-modulated radiotherapy:long-term results of 416 patients[J].Chin J Radiat Oncol,2012,21(3):196-200.DOI:10.3760/cma.j.issn.　1004-4221.2012.03.002.
[2]易俊林,高黎,徐国镇,等.147例鼻咽癌IMRT结果分析[J].中华放射肿瘤学杂志,2008,17(5):329-334.DOI:10.3321/j.issn.1004-4221.2008.05.001.
Yi JL,Gao L,Xu GZH,et al. Treatment results of intensity-modulated radiotherapy for nasopharyngeal carcinoma:an analysis of 147 patients[J].Chin J Radiat Oncol,2008,17(5):329-334.DOI:10.3321/ j.issn:1004-4221.2008.05.001.
[3]杨百华,陈英,徐鹭英,等.磁共振扩散加权成像在鉴别鼻咽癌放疗后鼻咽坏死与复发中的价值[J].中国癌症防治杂志,2011,3(4):298-302.DOI:10.3969/j.issn.1674-5671.2011.04.08.
Yang BH,Chen Y,Xu LY,et al. Values of diffusion-weighted imaging in differential diagnosing necrosis and recurrence of nasopharyngeal carcinoma after radiotherapy[J].Chin J Radiat Oncol,2011,3(4):298-302.DOI:10.3969/j.issn.1674-5671.2011.04.08.
[4]Marx RE.Osteoradionecrosis:a new concept of its pathophysiology[J].J Oral Maxillofac Surg,1983,41(5):283-288.DOI:10.1016/0278-2391(83)90294-X.
[5]华贻军,陈明远,洪明晃,等.内镜下鼻咽清创术治疗鼻咽癌放疗后鼻咽坏死20例近期疗效[J].癌症,2008,27(7):729-733.DOI:10.3321/j.issn:1000-467X.2008.07.011.
Hua YJ,Chen MY,Hong MH,et al. Short-term efficacy of endoscopy-guided debridement on radiation-related nasopharyngeal necrosis in 20 nasopharyngeal carcinoma patients after radiotheraphy[J].Chin J Cancer,2008,27(7):729-733.DOI:10.3321/j.issn:1000-467X.2008.07.011.
[6]黄晓东,易俊林,高黎,等.同步放化疗治疗晚期鼻咽癌Ⅲ期临床研究的初步疗效分析[J].肿瘤学杂志,2009,15(4):267-271.
Huang XD,Yi JL,Gao L,et al.Ⅲ phase clinical trial on concurrent chemotherapy and radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma[J].J Oncol,2009,15(4):267-271.
[7]陈春燕,赵充,高黎,等.西妥昔单抗联合同期顺铂化疗加IMRT局部晚期鼻咽癌的安全性研究[J].中华放射肿瘤学杂志,2012,21(3):201-204.DOI:10.3760/cma.j.issn.1004-4221.2010.3.003.
Chen CY,Zhao C,Gao L,et al. Multicenter safety study on cetuximab combined with intensity modulated radiotherapy and concurrent chemotherapy of cisplatin in locoregionally advanced nasopharyngeal carcinoma[J].Chin J Radiat Oncol,2012,21(3):201-204.DOI:10.3760/cma.j.issn.1004-4221.2012.03.003.
[8]吴君心,徐鹭英,杨百华,等.鼻咽癌放射治疗后鼻咽坏死60例临床分析[J].中华耳鼻咽喉头颈外科杂志,2012,47(3):185-190.DOI:10.3760/cma.j.issn.1673-0860.2012.03.003.
Wu JC,Xu LY,Yang BH,et al. Clinical analysis of 60 cases with radiative nasopharyngeal necrosis in nasopharyngeal carcinoma[J].Chin J Otorhinolaryngol Head Neck Surg,2012,47(3):185-190.DOI:10.3760/cma.j.issn.1673-0860.2012.03.003.
[9]Hua YJ,Chen MY,Qian CN,et al. Postradiation nasopharyngeal necrosis in the patients with nasopharyngeal carcinoma[J].Head Neck,2009,31(6):807-812.DOI:10.1002/hed.21036.
[10]Lee AWM,Ng WT,Hung WM,et al. Major late toxicities after conformal radiotherapy for nasopharyngeal carcinoma-patient-and treatment-related risk factors[J].Int J Radiat Oncol Biol Phys,2009,73(4):1121-1128.DOI:10.1016/j.ijrobp.2008.05.023.
[11]高黎,袁智勇,徐国镇,等.早期鼻咽癌单纯外照射与加近距离治疗的远期结果比较[J].中华放射肿瘤学杂志,2004,13(4):247-251.DOI:10.3760/j.issn:1004-4221.2004.04.001.
Gao L,Yuan ZY,Xu GZ,et al. Randomized trial on external radiation therapy alone versus external radiation therapy followed by brachytherapy in early stage nasopharyngeal carcinoma with a long term result[J].Chin J Radiat Oncol,2004,13(4):247-251.DOI:10.3760/j.issn:1004-4221.2004.04.001.
[12]肖建平,徐国镇,高黎,等.鼻咽癌初程放疗后残存的分次X刀治疗初探[J].中华放射肿瘤学杂志,2005,14(2):77-80.DOI:10.3760/j.issn:1004-4221.2005.02.002.
Xiao JP,Xu GZ,Gao L,et al. Fractionated radiosurgery for residual lesion after the first course of radiotherapy for nasopharyngeal carcinoma[J].Chin J Radiat Oncol,2005,14(2):77-80.DOI:10.3760/j.issn:1004-4221.2005.02.002.
[13]韩非,卢泰祥,赵充,等.放疗后局部复发的鼻咽癌IMRT的预后分析[J].中华放射肿瘤学杂志,2006,15(4):244-248.DOI:10.3760/j.issn:1004-4221.2006.04.003.
Han F,LU TX,Zhao C,et al. Prognostic analysis of intensity modulated radiotherapy for lacally recurrent nasopharyngeal carcinoma[J].Chin J Radiat Oncol,2006,15(4):244-248.DOI:10.3760/j.issn:1004-4221.2006.04.003.
[14]Xiao JP,Xu GZ,Miao YJ.Fractionated stereotactic radiosurgery for 50 patients with recurrent or residual nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2001,51(1):164-170.DOI:10.1016/S0360-3016(01)01623-6.
[15]Chen HY,Ma XM,Ye M,et al. Effectiveness and toxicities of intensity-modulated radiotherapy for patients with locally recurrent nasopharyngeal carcinoma[J].PLoS One,2013,8(9):e73918.DOI:10.1371/journal.pone.0073918.
[16]Qiu SF,Lin SJ,Tham IWK,et al. Intensity-modulated radiation therapy in the salvage of locally recurrent nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2012,83(2):676-683.DOI:10.1016/j.ijrobp.2011.07.006.
[17]Xia P,Fu KK,Wong GW,et al. Comparison of treatment plans involving intensity-modulated radiotherapy for nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2000,48(2):329-337.DOI:10.1016/S0360-3016(00)00585-X.