Nasopharyngeal Carcinoma Treated with Precision-oriented Radiation Therapy Techniques Including Intensity-modulated Radiotherapy: Preliminary Results

本研究報告鼻咽癌患者經強度調控放射治療的初步結果及治療相關的急性反應。從2000年到8月到2001年5月共有19位鼻咽癌患者接受以強度調控放射治療為主的治療，其中第一至第二期與第三至第四期的患者各有12及7位。有六位患者在接受強度調控放射線治療前先接受了三度空間順形放射治療，劑量是9.0-19.8葛雷。平均患者追蹤時間為13個月（8-18個月）。除了一位患者外，其餘第二期至第四期的患者皆在接受放射治療期間，接受兩個療程同步cisplatin及5-FU的化學治療；放療結束後再給予二至四個療程的輔助性化學治療。治療結果發現這19位患者原發及淋巴結的腫瘤均完全消失。在同步化學放射治療期間所發生的急性副作用包括：第三級黏膜反應有15位（79%），臨床上屬第一級的口乾症有9位，第二級的有9位，第三級的有一位。本研究結果發現合併三度空間順形療法、強度調控放射療法、腔內近接療法及化學療法是治療鼻咽癌的有效方法之一。雖然此方式對於耳下腺之保護較易達成但是保護成效仍然會受腫瘤期別、頸部淋巴結位置等因素所影響，因此更多的病例與更長時間的追蹤在此方面是必須的。

關鍵字

鼻咽癌；口乾症；強度調控放射療法

並列摘要

This paper reports preliminary results with intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma. Between August 2000 and May 2001, we treated 19 patients with NPC using IMRT. Twelve patients had stage I-II disease and seven had stage III-IV disease. Six patients received 9.0-19.8 Gy three-dimensional conformal radiotherapy (3D-CRT) before IMRT and 18 patients received a brachytherapy boost after IMRT. The mean follow-up time was 13.0 months. All patients with stage II-IV disease except one received two cycles of chemoradiotherapy with cisplatin and 5-fluorouracil (5-FU) during radiotherapy, followed by two to four cycles of chemotherapy after radiotherapy. Tumor response was assessed using clinical examination and computerized tomography or magnetic resonance imaging. The mean doses administered to the gross tumor volume and clinical tumor volume were 70.9Gy and 63.2Gy, respectively. The mean doses administered to the right and left parotid glands were 38.1Gy and 38.6Gy, respectively. All 19 patients had a complete response of primary and lymph node disease. Grade III mucositis developed during chemoradiotherapy in 15 patients (79%). In addition, clinical grade I xerostomia was recorded in nine patients, grade II in nine, and grade III in one. This study demonstrated that 3D-CRT, IMRT, intracavitary brachytherapy, and chemotherapy are effective and safe methods to treat NPC. Although IMRT treatment spared parotid gland function, its efficacy may be significantly influenced by disease stage and location of the neck lymph nodes. More cases and a longer follow-up to assess survival and complications are planned.

並列關鍵字

nasopharyngeal carcinoma ； xerostomia ； intensity-modulated radiotherapy

國際替代計量

Nasopharyngeal Carcinoma Treated with Precision-oriented Radiation Therapy Techniques Including Intensity-modulated Radiotherapy: Preliminary Results

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