Lee A W, Law S C, Foo W, Poon Y F, Chan D K, O S K, Tung S Y, Cheung F K, Thaw M, Ho J H
Institute of Radiology and Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Br J Radiol. 1993 Jun;66(786):528-36. doi: 10.1259/0007-1285-66-786-528.
This is a retrospective analysis of the long-term local control in 4128 patients with non-disseminated nasopharyngeal carcinoma treated solely by megavoltage irradiation during the years 1976-1985. The T-stage distribution according to Ho's classification was T1 37%, T2 14% and T3 49%. Different fractionation schedules had been employed at different periods, and the median dose to the primary target was equivalent to 65 Gy by time dose fractionation calculation. In 8% (344) of patients the tumour failed to regress completely after the basic course, but 89% (148/167) of those suitable for salvage with additional irradiation eventually attained complete local remission. The cumulative incidence of local failure was 24% (5% persistence, 19% recurrence). The 10-year actuarial local failure-free survival was 67%. While patients with T2 and T3a tumours achieved local control comparable to T1, those with T3c-d had the poorest control (with highest incidence of persistence and advanced recurrence). T-stage adjusted analyses suggested a significant trend of dose-response: the odds ratios for local failure were 1.16 and 1.86, respectively, when patients given 60-63 Gy and 55-59 Gy were compared with those given 64 Gy or above (p value = 0.0018). Patients treated during 1981-1985 achieved higher local failure-free survival than those treated during 1976-1980 (75% versus 70% at 5 years, p value = 0.0013). The possible attributes are studied, and ways for future optimization of treatment discussed.
这是一项对1976年至1985年间仅接受兆伏级放疗的4128例非播散性鼻咽癌患者的长期局部控制情况进行的回顾性分析。根据何氏分类法，T分期分布为：T1占37%，T2占14%，T3占49%。不同时期采用了不同的分割方案，通过时间剂量分割计算，原发靶区的中位剂量相当于65 Gy。8%（344例）的患者在基本疗程后肿瘤未完全消退，但在适合追加放疗挽救治疗的患者中，89%（148/167）最终实现了局部完全缓解。局部失败的累积发生率为24%（持续存在占5%，复发占19%）。10年精算局部无失败生存率为67%。虽然T2和T3a期肿瘤患者的局部控制情况与T1期相当，但T3c - d期患者的控制情况最差（持续存在和晚期复发的发生率最高）。T分期校正分析显示出显著的剂量 - 反应趋势：当将接受60 - 63 Gy和55 - 59 Gy的患者与接受64 Gy及以上的患者进行比较时，局部失败的优势比分别为1.16和1.86（p值 = 0.0018）。1981 - 1985年期间接受治疗的患者的局部无失败生存率高于1976 - 1980年期间接受治疗的患者（5年时分别为75%和70%，p值 = 0.0013）。研究了可能的影响因素，并讨论了未来治疗优化的方法。
