Chua Daniel T T, Wei William I, Sham Jonathan S T, Hung Kwan Ngai, Au Gordon K H
Department of Clinical Oncology, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):469-74. doi: 10.1016/j.ijrobp.2007.03.012.
Limited local failure of nasopharyngeal carcinoma (NPC) can often be salvaged by reirradiation using different techniques. Both gold grain implantation (GGI) and stereotactic radiosurgery (SRS) have been used as salvage treatment of NPC but the relative efficacy of these two treatments is not known.
A total of 74 patients with local NPC failure were included in this retrospective analysis. Of these patients, 37 underwent SRS (median dose, 12.5 Gy) and 37 split-palatal GGI at a dose of 60 Gy. The two groups were individually matched for prognostic factors, except for tumor volume. The median follow-up was 42 months.
Local control was better in the GGI group. The 3-year local failure-free rate was 77.9% for the GGI group compared with 68.3% for the SRS group. However, the difference was not statistically significant (p = 0.098). In the subgroup with a tumor volume of <or=5 cm3, the 3-year local failure-free rates were similar, with 79.3% in the GGI group and 72.4% in the SRS group. Neuroendocrine complications were more common in the SRS group, and headache and fistula were more common in the GGI group.
Stereotactic radiosurgery and GGI are both effective salvage treatment for NPC. In patients with limited local failure, both yielded comparable high tumor control rates.
鼻咽癌（NPC）的局限性局部复发通常可通过采用不同技术的再照射来挽救。金粒植入（GGI）和立体定向放射外科（SRS）均已被用作鼻咽癌的挽救性治疗，但这两种治疗方法的相对疗效尚不清楚。
本回顾性分析共纳入74例局部鼻咽癌复发患者。其中，37例接受了SRS（中位剂量12.5 Gy），37例接受了剂量为60 Gy的腭部劈开式GGI。除肿瘤体积外，两组在预后因素方面进行了个体匹配。中位随访时间为42个月。
GGI组的局部控制情况更好。GGI组的3年局部无复发生存率为77.9%，而SRS组为68.3%。然而，差异无统计学意义（p = 0.098）。在肿瘤体积≤5 cm3的亚组中，3年局部无复发生存率相似，GGI组为79.3%，SRS组为72.4%。SRS组的神经内分泌并发症更为常见，而GGI组的头痛和瘘管更为常见。
立体定向放射外科和GGI都是鼻咽癌有效的挽救性治疗方法。对于局部复发局限的患者，两者均能产生相当高的肿瘤控制率。
