鼻咽癌病人使用一日兩次多分次照射之急慢性副作用分析

目的：本文擬報告鼻咽癌病人以多分次放射照射法治療後，所發生的急慢性副作用，以作為臨床醫師選擇治療法時之參考。材料與方法：自民國八十年十月起至八十五年六月止，共給予五十例鼻咽癌病例使用多分次放射照射法，其中男病人35例、女病人15例。除兩例外均為AJCC第三或第四期。年齡自17至79歲不等，中值為51歲。治療採每日兩次間隔六小時。原發腫瘤一般在55-60天內給與7500-8000 cGy。治療中病人每週至少固定檢查一次，並將急性副作用詳細作成記錄記載於特別之表格。治療結束後每次回診，均詳細記錄病人之延發性晚期副作用。所有副作用之分級均按RTOG/EORTC之標準。結果：急性副作用方面，口乾最普遍，沒有一人倖免。口腔黏膜炎則出現在96%的病人，其中有62%為第三級。20例出現惡心嘔吐，除一例為嚴重的第三級之外，其餘屬輕微。頸部照射部位皮膚潰爛出現在8例。白血球減少並不常見而且大多為輕微降低。體重減輕平均降幅為8.2±0.6%。晚期副作用仍以口乾最常見，所有病人均受其苦。頭部軟組織纖維化的有13人(26%)，不過大多為輕微之第一級，出現Lhermitte's sign的有12個病人，此外並沒有出現其它神經症狀。聽力減退與中耳炎及鼻塞也有約五分之一左右的病人出現，牙關緊閉有兩例。另外有一例出現右下齒槽骨壞死。結論：多分次放射治療用於鼻咽癌病人，引發的急性口腔黏膜炎比率頗高，但並不致因此妨礙了治療進行。其它的急性副作用，基本上均屬輕微，或者與傳統治療法相當，病人所承受因治療帶來的壓力，似並不比傳統照射高。在晚期副作用方面，除一人發生骨壤死屬較嚴重的例子，其餘的副作用均屬一般傳統照射的範圍。不過仍需進一步追蹤，才能對於晚期副作用，作更準確的結論。在目前的階段，多分次放射治療理論上應不會增加晚期副作用、但會增加早期反應（及腫瘤控制率）的優點，若謹慎使用，不失為鼻咽癌病人在傳統照射法之外的另一選擇。

關鍵字

多分次照射；鼻咽癌；副作用

並列摘要

Purpose: To analyze the treatment-related acute and late toxicities of NPC patients after hyperfractionated radiotherapy. Materials and Methods: During the period from Oct. 1991 to June 1996, 50 patients were treated using hyperfractionated radiotherapy with 120 cGy bid and 6-hour intervals. There were 35 males and 15 females with the age range of 17-79. All except 2 cases were of AJCC stage III & IV. During the treatment period, acute toxicities were recorded once a week. Late toxicities were also evaluated on every follow-up visit after completion of radiotherapy. RTOG/EORTC criteria are used to grade toxicities. Results: Dry mouth was the most commonly found acute side effect affecting all patients. Acute mucositis developed in 96% of the patients, with 62% of grade 3. Nausea/vomiting occurred in 20 cases and were mostly mild except one. Moist desquamation was noted in 8 patients. Leukopenia was not frequent and mild. Body weight loss was 8.2±0.6%. For late toxicities, xerostomia was again the most common and affected all patients. Neck fibrosis was found in 13 patients (26%), mostly mild. Twelve patients developed Lhermitte's sign. No other neurological dysfunction has been noted. Hearing impairment was often associated with otitis media and occurred in about 1/ 5 of patients. Two patients had trismus, and one had radionecrosis at the posterior alveolar bone of the right mandible. Conclusions: Hyperfractionated radiotherapy induced a high proportion of mucositis. However, the patient tolerance was not compromised by this. Other acute toxicities resembled that after conventional radiotherapy both in frequency and severity. This also applied to late complications except one case with radionecrosis. Longer follow-up is needed before any definite conclusion can he made. At the present stage, hyperfractionated radiotherapy, with its theoretical advantages, appears to be a reasonable alternative to conventional radiotherapy for NPC patients.

並列關鍵字

Hyperfractionated radiotherapy ； Nasopharyngeal carcinoma ； Radiation toxicities

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鼻咽癌病人使用一日兩次多分次照射之急慢性副作用分析

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