原發部位之復發性鼻咽癌的再治療

林口長庚醫院放射腫瘤科自民國67年1月至76年12月底總計有789位鼻咽癌患者完成放射治療計劃，在民國78年12月底前被診斷有原發部位復發的104人經追蹤檢查至民國80年底而進入我們的分析。局限於鼻咽或其它地方軟組織的40例與合併有顱底或顱內侵犯的64例之2年存活率分別為30%及17%(P=0.22)。大於2年復發的35例與小於2年復發的69例之2年存活率分別為37%與16%(p=0.009)。無遠處轉移的90例進入我們再治療放射劑量的分析，如區分劑量為大或等於5000 cGy，小於5000 cGy，及無放射治療三組，2年及5年存活率分別為38%，28%，13%及23%，8%，0%(p=0.017)。接受化學治療3次或以上的30例之2年存活率為38%，少於3次或沒有接受治療的74例只有17%(p=0.009)。使用Cox Regression Model做多變數預後因子的分析，3項預後因子分別為第一次放射治療至復發時間超過兩年(P=0.0006)，再治療的劑量大或等於5000 cGy(P=0.0001)，以及接受3次或以上之化學治療(P=0.0001)。

關鍵字

鼻咽癌；鼻咽癌放射治療學

並列摘要

From 1978 through 1987, 789 cases of nasopharyngeal cancer completed planned radiotherapy in Lin-kou CGMH. There were 104 cases diagnosed to have primary local failure during the follow-up until 1989. Forty cases had the recurrence localized in nasopharynx and adjacent soft tissues, while 64 cases had concomitant skull base or intracranial invasion. Two-year survival rate was 30% and 17% respectively (p=0.22). Sixty-nine cases were found to have local failure within 2 years, while the disease-free interval of 35 cases were over 2 years. Two-year survival rate was 16% and 37% (p=0.009). Ninety cases without distant metastasis were analysed after salvage radiation therapy. They were grouped as those with re-irradiation dose over 5000 cGy, those with dose less than 5000 cGy and those who did not get any irradiation. The 2- and 5-year survival rates were 38%, 28%, 13% and 23%, 8%, 0%, respectively (p=0.017). Thirty cases who received three or more courses of chemotherapy in addition to the radiation therapy had 2-year survival rate of 38%, which was superior to the 17% of 74 cases receiving less than three courses. A multivariate analysis using Cox regression model showed that the disease-free interval, reirradiation dose over 5000 cGy, and three or more courses of chemotherapy are three independent prognostic factors.

並列關鍵字

Nasopharynx, neoplasm ； therapeutic radiology, nasopharynx

國際替代計量

原發部位之復發性鼻咽癌的再治療

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