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目的:分析T4期鼻咽癌适形调强放疗联合化疗的疗效及预后因素。方法:纳入2005年3月至2010年3月在我院初治的,无远处转移的110例T4期鼻咽癌患者。所有患者接受适形调强放疗,接受诱导和/或同步化疗。47例(42.7%)患者接受再程调强放疗。结果:中位随访58个月(12~120个月)。5年无局部复发生存率(local recurrence-free survival,LRFS),无区域复发生存率(regional recurrence-free survival,RRFS),无远处转移生存率(distant metastasis free-survival,DMFS),无进展生存率(progression-free survival,PFS)和总生存率(overall survival,OS)分别为90.1%,97.0%,67.5%,63.9%和64.5%。11例患者出现局部区域复发,共有34例患者出现远处转移。死亡45例患者中26例死于单纯远处转移。与未接受再程调强放疗相比,接受再程调强放疗的患者能获得更好的局部控制率(97.7%VS.83.8%,P=0.023)。咽后淋巴结转移具有较低的总生存率(61.0%VS.91.7%,P=0.034)。GTVln volume是DMFS和PFS的独立预后因素(P=0.006;P=0.018)。结论:适形调强放疗联合化疗提高T4期鼻咽癌的局部区域控制可行。再程调强放疗的获益与局控率提高相关。但远处转移是治疗失败的主要原因,降低远处转移率和增加生存率的治疗模式应该进一步探索。
Objective: To analyze the efficacy and prognostic factors of conformal intensity modulated radiation therapy combined with chemotherapy in patients with stage T4 nasopharyngeal carcinoma. Methods: A total of 110 patients with stage T4 nasopharyngeal carcinoma who had been treated in our hospital from March 2005 to March 2010 without distant metastasis were enrolled. All patients underwent IMRT and received induction and / or concurrent chemotherapy. Forty-seven patients (42.7%) underwent re-intensifying radiation therapy. Results: The median follow-up of 58 months (12 to 120 months). 5 years of local recurrence-free survival (LRFS), no regional recurrence-free survival (RRFS), no distant metastasis-free survival (DMFS), no progression The progression-free survival (PFS) and overall survival (OS) were 90.1%, 97.0%, 67.5%, 63.9% and 64.5% respectively. Local recurrence occurred in 11 patients and distant metastasis was observed in 34 patients. Of the 45 deaths, 26 died of simple distant metastases. Patients receiving reshonotherapy received better local control (97.7% VS.83.8%, P = 0.023) compared with those who did not receive rewarming. Posterior pharyngeal lymph node metastasis has a lower overall survival rate (61.0% VS.91.7%, P = 0.034). GTVln volume is an independent prognostic factor for DMFS and PFS (P = 0.006; P = 0.018). CONCLUSION: The conformal IMRT combined with chemotherapy can improve the local control of T4 NPC. The benefit of re-dilatation and radiation therapy is related to the increase of local control rate. However, distant metastasis is the main reason for the failure of treatment. The treatment modalities for reducing the distant metastasis rate and increasing the survival rate should be further explored.