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目的:探讨外照射配合咽旁间隙插植治疗鼻咽癌的价值。方法:初治的鼻咽癌患者常规行外照射68～70Gy后复查CT或MRI,有咽旁间隙残留的98例,随机分成2组。一组行咽旁间隙插植后装补量(插植组),共47例。插植的方法是在模拟定位机引导下,经颌下插入1～3根施源管至咽旁区。后装机采用核通公司生产的192Ir高剂量率近距离治疗机,补量12～15Gy/4～6次/2～3d(2次/d,2.5～4Gy/次,每次间隔>6h);另一组行耳后野补量12～14Gy(对照组),共51例。结果:插植组与对照组3年总生存率及3年无远处转移生存率,差异无显著意义(P>0.05);3年无局部复发生存率,插植组显著高于对照组(P<0.05);晚期放射反应中的口干及张口受限等,插植组显著低于对照组(P<0.05)。结论:做为鼻咽癌咽旁间隙的补量,咽旁间隙插植后装治疗可显著提高咽旁间隙区残留的局部控制率,且晚期放射反应显著低于耳后野补量照射,具有较理想的临床应用价值。
Objective: To investigate the value of external irradiation combined with parapharyngeal space implantation in the treatment of nasopharyngeal carcinoma. Methods: The newly diagnosed NPC patients underwent conventional CT or MRI after 68 ~ 70Gy external irradiation. There were 98 cases with residual parapharyngeal space and were randomly divided into 2 groups. A group of parapharyngeal space postoperative implant volume (implant group), a total of 47 cases. Implantation method is guided by simulated positioning machine, the submandibular insertion of 1 to 3 source tube to the parapharyngeal area. The installed capacity of 192Ir high dose rate brachytherapy machine produced by KETCO was 12 ~ 15Gy / 4 ~ 6 times / 2 ~ 3d (2 times / d, 2.5 ~ 4Gy / times, every interval> 6 hours) The other group of ears back field supplement 12 ~ 14Gy (control group), a total of 51 cases. Results: The 3-year overall survival rate and 3-year distant metastasis-free survival rate between the implant group and the control group were not significantly different (P> 0.05). There was no local recurrence after 3 years in the implant group and significantly higher than that in the control group P <0.05). In the late radiation reaction, the dry mouth and mouth opening were limited. The implanting group was significantly lower than the control group (P <0.05). Conclusion: As a supplement of parapharyngeal space of nasopharyngeal carcinoma, parapharyngeal space can improve the local control rate of residual parapharyngeal space after implantation, and the late radiation response is significantly lower than that of posterior rhynovium, with More ideal clinical value.