強度調控放射線治療對鼻咽癌患者治療之評估

Effects of Intensity-Modulated Radiotherapy on Patients with Nasopharyngeal Carcinoma

張宏育(Hung-Yu Chang) ； 劉文山(Wen-Shan Liu) ； 蘇茂昌(Mao-Chang Su) ； 辛宗翰(Chung-Han Hsin) ； 歐哲甫(Che-Fu Ou) ； 廖倩茹(Chien-Ru Liao)

《中山醫學雜誌》 14卷1期 (2003/01) Pp. 83-88

https://doi.org/10.30096/CSMJ.200301.0010

摘要

背景：放射線治療是目前鼻咽癌的首選治療方式，但傳統放射線治療所造成的副作用，如口乾症、張口困難、吞嚥疼痛、頸部組織纖維化等，除造成患者的痛苦，也使照射腫瘤的劑量無法提升，而使治療失敗。因此有效提高腫瘤照射劑量減少正常組織的傷害，便成為臨床治療上努力的目標。
方法：自2000年8月到2001年8月，共20位診斷為鼻咽癌並完成強度調控放射線治療的患者，均以AJCC97系統來分期，其中stage I 7位，stage IIa 2位，stage IIb 4位，stage III 5位，stage IVa 1位，stage IVb 1位。放射線療程的第１及第５週各給予cisplatin（60mg/m2）及5-FU（600mg/m2）進行為期１週的化學治療。stage III以上患者在放射線療程結束後再接受2次療程的化學治療。放射線療程結束後2週分2次給予7至8Gy近接治療(brachytherapy)。評估治療結果是在放射線治療結束2個月後進行頭頸部核磁共振造影；副作用則以口乾症(xerostomia)來評估，其中grade 0 為正常；grade 1 為略覺口乾但不影響進食；grade 2 為進食時須伴以液體；grade 3 是只能吃流質食物。
結果：20位患者自完成療程追蹤到2002年10月，平均20個月，都達到完全緩解(complete remission)，無復發現象；口乾症的程度15位grade 1，5位grade 2。
結論：強度調控放射線治療可有效提升腫瘤控率，並降低正常組織併發症的機率。

關鍵字

強度調控放射線治療,鼻咽癌,口乾症

並列摘要

Background: Nasopharyngeal carcinoma(NPC) is often seen in southern China. Radiotherapy is the therapy of choice, because NPC is highly radiosensitive and because tumor location at the skull base near its vital organs makes surgery difficult. Radiotherapy side effects such as xerostomia, trismus, odynophagia and cervical fibrosis can produce pain and discomfort severe enough for a patient to refuse further tumor irradiation. In such cases, simultaneously increasing control of tumor growth and reducing normal tissue complications present a radiotherapeutic challenge. Methods and Materials: Twenty proved cases of NPC, who finished a course of intensity-modulated radiotherapy (IMRT) from August 2000 to August 2001, were categorized according to AJCC 97 system: 7 were Stage I, 2 Stage IIa, 4 Stage IIb, 5 Stage III, 1 Stage IVa and 1 Stage IVb. Chemotherapy with cisplatin and 5-FU was routinely administered in week 1 and week 5. After the regular IMRT course, two more coursed of chemotherapy were administered to Stage III and Stage IV patients; brachytherapy with 7-8 Gy in 2 fractions was performed two weeks later. Two months later, MRI of the head and neck was done to evaluate the effects of IMRT. Degree of xerostomia was graded as follows: Grade 0, normal; Grad 1, no effect on swallowing, but some dryness sensation; Grade 2, swallowing with fluid is needed; Grade 3, liquid food only.
Results: Complete remission was achieved in the all 20 NPC patients following completion of IMRT course of therapy. Average follow-up was 20 months. No recurrence was noted. Fifteen Grade 1 and five Grade 2 cases of xerostomia were noted. No cased of Grade 3 xerostomia occurred. Conclusions: Intensity-modulated radiotherapy increased tumor control rate and decreases normal tissue complications simultaneously.

並列關鍵字

intensity-modulated radiotherapy (IMRT),nasopharyngeal carcinoma,(NPC) xerostomia