Gamma Knife Radiosurgery for Recurrent Nasopharyngeal Cancer

以加馬刀治療復發鼻咽癌

王令瑋(Ling-Wei Wang) ； 蕭正英(Cheng-Ying Shiau) ； 鍾文裕(Wen-Yu Chung) ； 潘宏基(David Hung-Chi Pan) ； 郭萬祐(Wan-Yuo Kuo) ； 吳秀美(Hsiu-Mei Wu) ； 梁棉榮(Mien-Jung Leung) ； 季匡華(Kwan-Hua Chi) ； 許志宏(Chih-Hung Hsu) ； 陳盛鈺(Sheng-Yu Chen) ； 李鳳嬌(Fe)

《放射治療與腫瘤學》 10卷3期 (2003/09) Pp. 119-126

https://doi.org/10.6316/TRO/200310(3)119

摘要

目的：探討以加馬刀治療放療後復發之鼻咽癌的結果。
材料與方法：自1993至1997年，共有十一位（六男五女）放療後復發的鼻咽癌病患接受加馬刀放射手術治療，首次放療與加馬刀的間隔時間是一至十二年（中位值二年）。加馬刀的治療劑量是12.5至20 Gy（中位值15 Gy），腫瘤體積是從小於1至33 cc（中位值11 cc），放療所照體積（Radiation Volume）是6至48 cc（中位值20.9 cc）經由回溯研究這些病人根據治療種類的不同而分為兩組：有四位病人僅接受加馬刀而無接受傳統放療（A組）。另七名病人除加馬刀外接受傳統的分次體外放療（劑量30至47 Gy，中位值38 Gy），及同步化療（Cisplatin，5FU及Mitomycin C），是為B組。
結果：所有病人都能完成加馬刀治療而無明顯之急性副作用。在九位有做MRI檢查的病人中有八位都看到腫瘤縮小。在A組病人中只有一位病人死於同步化療引起之敗血症，一位在六個月內死亡，另兩位病人在十五個月內復發。在B組病人中，有五位病人腫瘤長期控制良好。但這其中有三位病人在治療後MRI上發現有明顯的腦部損傷。所有病人的中位存活期為48.8個月,五年存活率為36.4%。
結論：加馬刀合併分次放療及同步化療對復發鼻咽癌似乎可以比單獨加馬刀達到較好的療效。分次放療宜避免用兩側對照的照野以免腦部損傷。

關鍵字

鼻咽癌 ； 復發 ； 放射手術 ； 合併療法

並列摘要

Purpose : To report the results of salvage treatment of recurrent nasopharyngeal cancers (NPC) using Gamma Knife radiosurgery (GK) alone or combined with conventional radiotherapy.
Materials and methods : From 1993 to 1997, eleven patients (6 males and 5 females) were diagnosed to have recurrent tumors over the primary site of nasopharynx and/or skull base at our hospital after initial radiotherapy. The time interval between the primary radiotherapy and salvage GK was 1 to 12 years (median = 2.0 years). All patients received single fraction of Gamma Knife radiosurgery was performed with peripheral doses of 12.5 to 20 Gy (median = 15 Gy) to cover the recurrent tumor as conformal as possible. The tumor volumes (TV) were less than 1 to 33 cc (median = 11cc) whereas radiation volumes (RV) were 6 to 48 cc (median = 20.9 cc). Retrospectively the patients were divided into two groups according to their treatment. Four patients received GK without further radiotherapy (Group A). The other 7 patients received hyperfractionated external beam radiotherapy of 30 to 47 Gy (median = 38 Gy) and concurrent chemotherapy (cisplatin, 5-FU, mitomycin C) for further boost of the tumor (Group B).
Result : All patients tolerated GK well without significant acute toxicity. The first MRI after GK showed tumor regression for eight out of nine patients receiving this examination. One patient died of sepsis induced by concurrent chemotherapy, not receiving fractionated RT. For the other 3 patients receiving GK without combined RT (group A), 2 tumors recurred 7 and 15 months later and one patient lost to image follow-up and expired within 6 months after GK. Five out of seven patients of group B remained local control at the last image follow-up (6 to 62 months after GK). However, three patients of this group of had prominent brain damage shown by MRI and PET scan after salvage irradiation. The median survival of all our patients is 48.8 months. The five-year survival rate is 36.4%.
Conclusion : Combined fractionated RT, GK radiosurgery and concurrent chemotherapy seem to achieve better local control for intracranially recurrent NPC than GK alone. It is not recommended to use single-fraction radiosurgery to salvage a newly diagnosed skull base recurrent NPC. Bilateral opposing fields in fractionated RT should be avoided to lower the incidence of late complications.

並列關鍵字

Nasopharyngeal cancer ； Recurrence ； Radiosurgery ； Combined treatment