加速式放射治療應用於鼻咽癌之經驗

Accelerated Radiotherapy for Nasopharyngeal Carcinoma

詹建勝(Jian-Sheng Jan) ； 林進清(Jin-Ching Lin)

《放射治療與腫瘤學》 4卷4期 (1997/12) Pp. 243-249

https://doi.org/10.6316/TRO/199704(4)243

摘要

目的：改變分次的放射治療已被證實可以提高腫瘤控制率，本前瞻性研究係探討每天照射二次之加速式放射治療對鼻咽癌之可行性、療效及副作用。
材料與方法：自民國八十一年十二月至八十四年十二月，共有43位鼻咽癌病人進入本研究，其中男性32例、女性u例，年齡介於28至78歲，大多數病人病理切片屬於分化很差或未分化癌，根據1958年AJCC分期系統，第二期一例，第三期五例，三十七例（86.1%）屬於第四期。加速式放射治療方式如下：每天照射二次，每次1.5Gy，上下午治療至少隔六小時,每週照射五天•總劑量為72Gy/4分次/5週。
結果：病人的急性副作用，主要是口腔黏膜發炎反應（56%達第三、四級）和皮膚反應（60%達第三、四級｝。有11例因毒性反應在接受約三週加速式放射治療後•要求改為傳統分次治療，每天只照射一次，另有2例分別休息二和四週之久。雖然如此，所有病人都能完成足量的放射治療，平均每人接受72Gy/47分次（67.5至79Gy)，平均治療時間38天。迄今追踪時問已24至60個月（中值追跌時間41個月），目前治療失敗者有15例，單獨鼻咽部復發4例，鼻咽部合併遠處轉移者1例，1例先發生遠處轉移後又發生鼻咽部及頸部淋巴復發，其他9例都是遠處轉移，三年鼻咽部控制率邵餛，頸部控制率97.3%，遠處轉移控制率71.2%, 三年總存活率54.1%，三年無病存活率焉65.7%。
結論：加速式放射治療對晚期鼻咽癌是可行且根有效的治療方式，遠處轉移是治療失敗的主要原因，放療後再追加輔助性化學治療，以減少遠處轉移發生，提高存活率，值得進一步研究“［放射治療與腫瘤學1997;4:243-249］

關鍵字

加速式 ； 放射治療 ； 鼻咽癌

並列摘要

Purpose: Altered fractionated radiotherapy can enhance the local control in many types of tumor when compared with conventional radiotherapy, especially for head and neck cancer. The purpose of this prospective phase II study is to evaluate the feasibility, response and toxicities of accelerated radiotherapy for nasopharyngeal carcinoma (NPC).
Materials and Methods: Through December 1992 to December 1995, 43 patients with pathologically documented NPC were entered. There were 32 male and 11 female with a median age of 51 years (range 28-78). The pathology of most patients (91%) belongs to WHO type II and III. According to 1988 AJCC staging system, 37 patients (86.1%) were stage IV, 5 (11.6%) stage III, and 1(2.3%) stage II. The accelerated radiotherapy consists of 1.5 Gy/fraction, two fractions per day, with at least a 6-hour interval. The total dose is usually 72 Gy/48 fractions in 5 weeks.
Results: The major toxicities were mucositis and skin reaction. Grade 3/4 mucositis occurred in 24 patients (55.8%) and grade 3/4 skin reaction in 26 patients (60.5%). Eleven patients asked to change to conventional radiotherapy (1.8-2.0 Gy/fraction, one fraction per day) during the later part of radiotherapy, and 2 patients had interruption for 2 and 4 weeks. Although the original accelerated schedule in 13 patients were modified, all patients completed the treatment with average dose 72 Gy/47 fractions/38 days (range 67.5-79 Gy). After a median follow-up time of 41 months (range 24-60), the nasopharynx disease-free, neck disease-free, and distant metastasis disease-free survivals are 86.6%, 97.3%, and 71.2% respectively. The 3-year overall survival and disease-free survival are 54.1% and 65.7%. Most patients failed due to distant metastases.
Conclusion: Our data indicate that accelerated radiotherapy for advance NPC is both feasible and effective, with acceptable toxicities. Post-radiation adjuvant chemotherapy to eradicate subclinical micrometastasis should be further studied.
［Therapeut Radiol Oncol 1997; 4:243-249］

並列關鍵字

Accelerated ； Radiotherapy ； Nasopharyngeal carcinoma