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目的:探讨后程加速超分割放射治疗N3期鼻咽癌临床疗效。方法:60例N3期鼻咽癌患者随机分为后程加速超分割放射治疗组(LCAF组)30例,常规分割放射治疗组(CF组)30例。其中LCAF组先用常规分割照射,2.0 Gy/次,5次/周,放量达36~40 Gy后改用LCAF照射,1.5 Gy/次,2次/d,中间间隔6~8 h,每周放疗5 d,休息2 d,鼻咽癌放疗总量约68~76 Gy/6~6.5周,颈部放疗量为60~70 Gy/5.5~6周。CF组全部按常规分割放射治疗,鼻咽部放疗量为72~76 Gy/7~7.5 w,颈部放疗量为60~70 Gy/6~7 w。结果:鼻咽部肿瘤完全缓解率(CR)LCAF组和CF组分别为86.7%(26/30)、60%(18/30);颈部淋巴结完全缓解率(CR)LCAF组和CF组分别为90%(27/30)、56.6%(17/30),两组间比较有显著性意义(P<0.05)。1、3、5年生存率LCAF组分别为86.7%、73.3%、23.3%,CF组分别为80%、66.7%、20%,两组间差异无显著性意义(P>0.05)。鼻咽部5年局部控制率LCAF组为93.3%,CF组为80%;颈部淋巴结5年局部控制率LCAF组为86.7%,CF组为73.3%,两组间差异无显著性意义(P>0.05)。两组放疗毒副反应也无显著差异(P>0.05)。结论:后速加速超分割放射治疗N3期鼻咽癌较常规分割放射治疗具有更好近期疗效,但未能提高5年生存率及局部控制率,有必要扩大病例并作长期随访研究。
Objective: To investigate the clinical effects of late accelerated hyperfractionation radiotherapy for N3 stage nasopharyngeal carcinoma. Methods: Sixty N3 stage NPC patients were randomly divided into 30 cases of LCAF group and 30 cases of conventional radiotherapy group (CF group). The LCAF group was irradiated with LCAF at a dose of 36 Gy to 40 Gy after irradiation at a dose of 2.0 Gy / second, twice a day, twice a day for 6-8 h, Radiotherapy 5 d, rest 2 d, radiotherapy of nasopharyngeal carcinoma total about 68 ~ 76 Gy / 6 ~ 6.5 weeks, cervical radiotherapy volume 60 ~ 70 Gy / 5.5 ~ 6 weeks. Radiotherapy was performed on all the patients in the CF group according to the conventional radiotherapy. The radiotherapy amount was 72-76 Gy / 7-5.5 w in the nasopharynx and 60-70 Gy / 6-7 w in the neck. Results: The complete response rate (CR) of nasopharyngeal tumor in LCAF group and CF group were 86.7% (26/30) and 60% (18/30), respectively. The complete response rate (LCAF) and CF group (27/30) and 56.6% (17/30), respectively. There was a significant difference between the two groups (P <0.05). The 1-, 3- and 5-year survival rates in LCAF group were 86.7%, 73.3% and 23.3%, respectively, and those in CF group were 80%, 66.7% and 20% respectively. There was no significant difference between the two groups (P> 0.05). The 5-year local control rate of nasopharynx was 93.3% in LCAF group and 80% in CF group. The 5-year local control rate of cervical lymph node in LCAF group was 86.7% in LCAF group and 73.3% in CF group. There was no significant difference between the two groups > 0.05). There was no significant difference between the two groups in side effects of radiotherapy (P> 0.05). CONCLUSION: Post-accelerated accelerated hyperfractionation radiotherapy is more effective than conventional fractionated radiotherapy in the treatment of N3-stage NPC, but it fails to improve the 5-year survival rate and local control rate. It is necessary to expand the case and make long-term follow-up studies.