Antognoni P, Bossi A, Molteni M, Richetti A, Tordiglione M
Divisione di Radioterapia, Ospedale Multizonale, Varese.
Radiol Med. 1990 Nov;80(5):703-8.
From December 1979 to December 1986, 100 patients affected with nasopharyngeal carcinoma, staged according to TNM (UICC-1978) criteria received exclusive radiation therapy at the Radiotherapy Department of the General Hospital of Varese. The median follow-up is 36 months (range: 1-114). Irradiation was delivered with 10 MV photons (58 patients) or 60Co (42 patients), with two opposed parallel lateral fields and progressive shrinkage, or rotation technique. Direct fields of electron beams (6-15 MeV) were employed as boosts on the residual nodes. Median total dose: 60 Gy to T, 46 Gy to N0, 62 Gy to N1-3. A conventional fractionation (2 Gy once a day, 5 times a week) was used in 43 patients, while an accelerated hyperfractionated regimen (1.5 Gy twice a day, 5 times a week) was employed in 57 patients. Five-year overall survival (Kaplan-Meier) of the 100 treated patients is 54.9%, while 5-year disease-free survival of the 71 patients in complete clinical remission at the end of radiation therapy is 54.7%. The nodal status represents the most important prognostic variable: 5-year overall survival (100 patients) is 77.7% for N0 patients and 40.8% for N1-3 patients, while 5-year disease-free survival for the 71 patients in clinical remission at the end of radiation therapy is 78.9% and 48.8% for N0 and N1-3 patients respectively. Our findings confirm the high rescue rate (approximately 50%) of irradiation failures by re-irradiation and/or salvage surgery. The analysis of loco-regional recurrences and persistent disease, after radiotherapy, strongly suggests the need for an improvement in loco-regional control rates, by means of a more accurate treatment planning (with CT and MR) and more attention to isoeffect parameters (CRE). The incidence of distant metastases (14%) and difficulties in loco-regional control of advanced disease seem to suggest the use of combined chemo-radiotherapy modalities only for selected groups of patients and exclusively in randomized studies.
1979年12月至1986年12月，100例根据TNM（UICC - 1978）标准分期的鼻咽癌患者在瓦雷泽综合医院放疗科接受了单纯放射治疗。中位随访时间为36个月（范围：1 - 114个月）。采用10兆伏光子（58例患者）或钴 - 60（42例患者）进行照射，使用两个相对的平行侧野并逐步缩野，或采用旋转技术。电子束直接野（6 - 15兆电子伏）用于对残留淋巴结进行追加照射。中位总剂量：T区为60戈瑞，N0区为46戈瑞，N1 - 3区为62戈瑞。43例患者采用常规分割（每天2戈瑞，每周5次），而57例患者采用加速超分割方案（每天2次，每次1.5戈瑞，每周5次）。100例接受治疗患者的5年总生存率（Kaplan - Meier法）为54.9%，而放疗结束时临床完全缓解的71例患者的5年无病生存率为54.7%。淋巴结状态是最重要的预后变量：100例患者中，N0患者的5年总生存率为77.7%，N1 - 3患者为40.8%；放疗结束时临床缓解的71例患者中，N0和N1 - 3患者的5年无病生存率分别为78.9%和48.8%。我们的研究结果证实了再次照射和/或挽救性手术对放疗失败的高挽救率（约50%）。放疗后对局部区域复发和持续性疾病的分析强烈表明，需要通过更精确的治疗计划（采用CT和MR）以及更多关注等效应参数（CRE）来提高局部区域控制率。远处转移的发生率（14%）以及晚期疾病局部区域控制的困难似乎表明，仅对选定的患者群体且仅在随机研究中使用联合放化疗模式。
