Lee A W, Sham J S, Poon Y F, Ho J H
Institute of Radiology and Oncology, Medical and Health Department, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Int J Radiat Oncol Biol Phys. 1989 Dec;17(6):1183-90. doi: 10.1016/0360-3016(89)90524-5.
This is a retrospective analysis of 196 patients with nasopharyngeal carcinoma Stage I (Ho's classification) treated by megavoltage radiation during 1980-1984. The primary target volume included all potential sites of local invasion and the first station lymph nodes at retropharyngeal spaces. Two different dose schedules were used, both gave a total tumor dose biologically equivalent to 65 Gy by conventional fractionation, and both achieved a 5-year actuarial local-recurrence-free survival of 88%. Elective neck irradiation was withheld in all except seven patients. The overall 7-year actuarial survival was 85%, but the relapse-free survival was only 62%. The patterns of relapse, prognostic factors, and treatment complications were analyzed. Eighteen patients (9%) recurred locally. Radical retreatment with radiation achieved complete remission in seven out of fifteen cases. Distant failure occurred in 17 patients (9%). Although 57 (30%) of the 189 patients without elective neck irradiation subsequently showed lymph node involvement, none of the seven regionally-treated patients relapsed. The successful regional salvage rate was 81% overall (46 out of 57 patients), but 90% (44 of 49) for those properly treated with whole neck irradiation. However, the 7-year actuarial survival was lower in patients with nodal relapse than those without (70% versus 87%) because of the associated higher incidence of hematogenous dissemination. The various aspects of treatment, the value of elective neck irradiation in particular, are discussed.
这是一项对1980年至1984年间接受兆伏级放疗的196例I期鼻咽癌患者（何氏分类）的回顾性分析。主要靶区包括所有潜在的局部侵犯部位以及咽后间隙的第一站淋巴结。采用了两种不同的剂量方案，两种方案给予的总肿瘤剂量在生物学上等同于常规分割的65 Gy，且两者的5年精算局部无复发生存率均为88%。除7例患者外，所有患者均未进行选择性颈部照射。总体7年精算生存率为85%，但无复发生存率仅为62%。对复发模式、预后因素和治疗并发症进行了分析。18例患者（9%）出现局部复发。15例患者中有7例通过根治性再放疗实现了完全缓解。17例患者（9%）发生远处转移。尽管189例未进行选择性颈部照射的患者中有57例（30%）随后出现淋巴结受累，但7例接受区域治疗的患者均未复发。总体而言，成功的区域挽救率为81%（57例患者中有46例），但对于接受全颈照射的合适患者，挽救率为90%（49例中有44例）。然而，由于血行转移发生率较高，有淋巴结复发的患者7年精算生存率低于无淋巴结复发的患者（70%对87%）。本文讨论了治疗的各个方面，特别是选择性颈部照射的价值。
