【摘要】 目的 观察鼻咽癌调强适形放射治疗(IMRT)联合化疗的耐受性和近期临床疗效。方法 初治晚期鼻咽癌患者85例Ⅲ期55例,Ⅳa期30例。将鼻咽和颈部的靶体积划分为鼻咽大体肿瘤体积(GTV1)、颈部大体肿瘤体积(GTV2)、临床靶体积1(CTV1)和临床靶体积2(CTV2)。化疗选择FP±THP或TP方案，采用Kaplan-Meier法进行生存分析,RTOG/EORTC标准评价急性反应和晚期损伤。结果 IMRT使靶体积照射总剂量和分次剂量提高,而危及器官受照总剂量和分次剂量降低。患者近期毒副反应可以耐受,口干症状随着治疗后时间的延长口干逐渐减轻。结论 IMRT初治鼻咽癌可获得理想的局部区域控制,对正常组织器官有较好的保护作用；放化综合治疗对控制远处转移有一定价值。

    【关键词】 鼻咽肿瘤 调强放射治疗 化疗 预后

    Clinical Study of First-treated Late Nasopharyngeal Carcinoma Patients for Intensity Modulated Radiation Therapy (IMRT) with Combined Chemotherapy

    He Xia, et al.

    (Department of Radiotherapy, Jiangsu Cancer Hospital, Nanjing, Jiangsu 210009,China)

    【Abstract】 Objective To study tolerate of radiation therapy with combined chemotherapy、clinical efficacy of intensity modulated radiation therapy (IMRT) for first-treated late nasopharyngeal carcinoma. Methods Between Dec 2003 and Dec.2005, 85 patients of first-treated late nasopharyngeal carcinoma underwent IMRT at the Jiangsu Cancer Hospital. According to the Fuzhou Staging Classification, 55 patients were stage Ⅲ,and 30 stage Ⅳ. The prescription dose was engaged to the gross target volume (GTV1), positive neck lymph nodes (GTV2),clinical target volume1(CTV1) and CTV2 Of these patients received 1 or 2 courses concurrent chemotherapy, and the chemotherapy regiment was PDD+5-Fu±THP-ADM. Or PDD+Taxol. Acute and late toxicities were graded according to RTOG radiation morbidity scoring criteria. Results IMRT improved the total dose and dose perfraction to the target volume with significant sparing of the normal structures at the same time. Xerostomia could be tolerated and decreased with time going. Conclusions IMRT yields well dose distribution and acceptable toxity in first-treated late nasopharyngeal carcinoma. Radiation therapy combined with chemotherapy is effective to control distant metastasis. ......