不同照射野治疗76例双侧咽旁间隙受侵鼻咽癌疗效观察.docVIP

不同照射野治疗76例双侧咽旁间隙受侵鼻咽癌疗效观察 　【关键词】 鼻咽肿瘤/放射治疗；咽旁间隙侵犯 　　摘要：目的：观察比较76例双侧咽旁间隙侵犯的鼻咽癌病人采用两种不同照射方式治疗的疗效。方法:1999年1月至2000年4月我院76例双侧咽旁间隙侵犯的鼻咽癌病例均经病理和CT证实，随机分成两组：对照组和放疗组各38例。对照组采用面颈联合野放疗至36Gy，鼻咽改用双耳前野、鼻前野，颈部采用颈前分割野放疗。放疗组在对照组基础上增加我们自己设计的颈后分割野，并将颈后分割野提高扩大至外耳孔上缘，同时使用双外侧挡块保护双下颌支。结果：治疗组咽旁肿物消退率及3、5年存活率明显高于对照组。放射性脊髓炎、放射性脑病两组比较差异无显著性，（Pgt;0.05）。结论：对于双侧咽旁间隙受侵的鼻咽癌病人，我们设计改进的颈后分割野能明显提高疗效。 　　关键词：鼻咽肿瘤/放射治疗；咽旁间隙侵犯 　　The Radiotherapy Effects of 76 Cases of Nasopharyngeal Carcinoma with　Involvement of Bilateral Pharyngeal Space Treated by Different Protocols 　　　Abstract： Objective: To compare the radiotherapy effects of 76 cases of nasopharyngeal carcinoma with involvement of bilateral pharyngeal space treated by different protocols. Method: 76 cases of nasopharyngeal carcinoma with bilateral pharyngeal space invasion were confirmed by pathology and CT scan. The patients were divided into two groups randomly.（treatment group and control group）. Each one has 38 patients. The control group adopted lateral faciocervial portal with total dose 36Gy firstly .Then the neck adopted anterior-cervial partition portal. The treatment group adopted lateral faciocervial latleral portal firstly. Then the neck adopted retrocervial partition portal. Which designed by ourselves. We enlarge the portal to the exterior auditory meatus. Result: The local control rate and the 3 to 5 years survival rate in treatment group were higher than in the control group. Radiospinitis and radioactive brain injury in treatment group was no different from that of control group ,（Pgt;0.05）.Conclusion: The retro-cervial partition portal. Which designed by ourselves, can be considered as an effective and feasible approach to treat nasopharyngeal carcinoma with involvement of bilateral pharyngeal space. 　　Key words：Nasopharyngeal carcinoma/radio therapy;Pharyngeal space invasion 　　随着CT及MRI的普及应用，对鼻咽癌侵犯范围的了解越来越明确，文献报道，鼻咽癌就诊时咽旁间隙受累率达73.6%～91%，双侧同时受累约占27%［1,2］。双侧咽旁侵犯鼻咽癌的治疗是临床治疗难题，我们自己设计改进的颈后分割野照射双侧咽旁间隙，取得较好的疗效，报告如下： 　　1材料与方法 　　1.1一般资料：从19