Vikram B, Mishra U B, Strong E W, Manolatos S
Int J Radiat Oncol Biol Phys. 1985 Aug;11(8):1455-9. doi: 10.1016/0360-3016(85)90332-3.
Between 1970 and 1980, we treated 107 previously untreated patients with biopsy proven carcinoma of the nasopharynx by megavoltage external radiation therapy to the primary site, base of the skull and both sides of the neck. Fifty-three percent of the patients had T4 primaries and 87% had Stage IV disease. The histology was poorly differentiated, undifferentiated or anaplastic carcinoma in 81% of the patients, and well differentiated or moderately well differentiated epidermoid carcinoma in 19%. The dose of irradiation to the primary site ranged from 5700 to 7700 rad. Fifty-five patients have suffered relapse of the cancer, 33 of whom (60%) relapsed at the primary site. Seventy-two percent of the relapses at the primary site appeared within two years after treatment and 91 percent within 3 years. Median survival following relapse at the primary site was 10 months. Those patients who received a dose to the primary between 5700 and 6700 rad had a lower rate of local control than those who received a dose between 6700 and 7700 rad. However, regardless of the dose, those patients whose radiation therapy was interrupted (for whatever reason) for a total of three weeks or longer had poorer local control than those patients whose treatment was not so interrupted. The highest rate of local control (84%) was observed in those patients who did not have such interruptions and received a dose of 6700-7700 rad to the primary. Improved local control with the higher doses was especially striking for T4 primaries, suggesting a dose-response relationship. The local control rate did not appear to be significantly influenced by age, sex, birthplace or histology. These data suggest that a high rate of local control is possible in carcinoma of the nasopharynx, even with T4 disease, if a sufficiently high dose of radiation therapy is delivered without undue interruptions.
1970年至1980年间，我们对107例经活检证实的鼻咽癌初治患者进行了兆伏级外照射治疗，照射部位包括原发灶、颅底及双侧颈部。53%的患者原发灶为T4期，87%的患者为IV期。81%患者的组织学类型为低分化、未分化或间变癌，19%为高分化或中分化表皮样癌。原发灶的照射剂量为5700至7700拉德。55例患者出现癌症复发，其中33例（60%）在原发灶复发。原发灶复发的患者中，72%在治疗后两年内出现复发，91%在3年内出现复发。原发灶复发后的中位生存期为10个月。接受5700至6700拉德原发灶照射剂量的患者局部控制率低于接受6700至7700拉德照射剂量的患者。然而，无论照射剂量如何，放疗因任何原因中断累计达三周或更长时间的患者，其局部控制情况均不如未中断治疗的患者。在未出现此类中断且原发灶接受6700 - 7700拉德照射剂量的患者中，观察到最高的局部控制率（84%）。对于T4期原发灶，较高剂量照射带来的局部控制改善尤为显著，提示存在剂量 - 反应关系。局部控制率似乎未受到年龄、性别、出生地或组织学类型的显著影响。这些数据表明，即使是T4期疾病的鼻咽癌患者，如果给予足够高的放疗剂量且无不当中断，也有可能实现较高的局部控制率。
