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目的:分析84例局部晚期鼻腔鼻窦肿瘤放射治疗的疗效和影响因素。方法:对2006-2008年我科共治疗的84例局部晚期(T3、T4期)鼻腔鼻窦肿瘤患者的临床资料进行回顾性分析。结果:1、2、3年生存率及总生存率分别为93.5%、71.3%、46.2%和82.1%。单因素分析显示,性别、放化疗、病理类型与生存率无相关性,而T分期、放疗剂量、放疗技术、手术后联合放疗与生存率相关。多因素分析显示,T3期、手术后联合放疗、放疗剂量>70 Gy、调强放疗均是影响患者生存率的独立预后因素。即肿瘤T分期相对较早(T3期),能够行手术切除,术后配合调强放疗,给予相对较高的放疗剂量(>70 Gy),患者生存率就能从中获益。IMRT组与3D-CRT组放疗后口干发生率分别为2.4%和7.1%,P=0.03。结论:放射治疗是局部晚期鼻腔鼻窦肿瘤有效的治疗手段,术后放疗能明显提高生存率。调强放疗较三维适形放疗在鼻腔鼻窦肿瘤治疗中,能明显提高靶区剂量,进而提高生存率,同时降低口干发生率,且没有Ⅲ级以上的晚期毒副反应的发生,调强放疗应被视为局部晚期鼻腔鼻窦肿瘤的标准治疗方法。
Objective: To analyze the curative effect and influencing factors of radiotherapy in 84 cases of locally advanced nasal sinus tumors. Methods: The clinical data of 84 patients with locally advanced (stage T3, T4) nasal sinus cancer treated in our department from 2006 to 2008 were analyzed retrospectively. Results: The 1, 2, 3 year survival rates and overall survival rates were 93.5%, 71.3%, 46.2% and 82.1% respectively. Univariate analysis showed no correlation between gender, radiotherapy and chemotherapy, pathological type and survival rate, but T stage, radiation dose, radiotherapy technique and postoperative radiotherapy were related to survival rate. Multivariate analysis showed that T3, postoperative combined radiotherapy and radiotherapy dose> 70 Gy, IMRT were independent prognostic factors affecting the survival rate of patients. That is, the tumor T stage relatively early (T3), can be surgically removed, combined with IMRT after surgery, given a relatively high dose (> 70 Gy), the patient survival rate can benefit. The rates of dry mouth after IMRT and 3D-CRT were 2.4% and 7.1%, respectively, P = 0.03. Conclusion: Radiotherapy is an effective treatment for locally advanced nasal sinus tumors. Postoperative radiotherapy can significantly improve the survival rate. Intensity modulation radiotherapy than three-dimensional conformal radiotherapy in the treatment of nasal sinus cancer, can significantly increase the target dose, thereby increasing the survival rate, while reducing the incidence of dry mouth, and no grade Ⅲ advanced toxic side effects, intensity modulated radiotherapy Should be considered as a standard treatment of locally advanced nasal sinus tumors.