| ObjectiveNasopharyngeal carcinoma is one of common malignant tumors in China,in the head and neck malignancies accounted for the first.Due to complicated clinical manifestations, easily by the patient and medical personnel to ignore and misdiagnosis,missed diagnosis.The radiation therapy is now the preferred treatment. Prognosis is not very clear at present,Therefore,this study will follow up of 487 patients with nasopharyngeal carcinoma, the clinical stage,pathological type,different patterns of radiotherapy and radiotherapy dose on patient survival and local control rates of statistics and analysis.To clear the factors of affecting the prognosis of nasopharyngeal carcinoma, to guide the clinical treatment.Methods1. Subjects: 487 patients with nasopharyngeal carcinoma derived from patients in the department of Radiotherapy of Second Hospital of Jilin University from January 1, 2001 to December 31, 2005. The 369 cases is male patients, female patients is118 cases, the minimum age of the patients was 7 years, the highest in patients is 81 years. In 25 cases of patients is clinical stage I, stage II is 187 patients, stageⅢis 187 patients, 102 cases of patients with stage IV. The patients treated by nasal endoscopic biopsy pathology, including high differentiated squamous cell carcinoma 122 cases, low differentiation in 323 cases, 35 cases of undifferentiated carcinoma, 2 cases of adenocarcinoma, 5 cases of adenoid cystic carcinoma. Before treatment were treated with CT or MRI checks to clear the tumor staging.2. Treatment methods2.1 radiation therapyConventional radiation therapy: conventional radiotherapy used X-ray simulation location machine positioning, and used bilateral faciocervical fields and the lower cervical supraclavicular wild tangent. Irradiation field design is accorded to the bony landmarks and CT imaging or magnetic resonance imaging, to determine the field boundaries. Usually if the skull without invasion, portal upper bounds in cranial base line on 0.5cm, if there is violation according to tumor bound, to 1cm. The lower bound is subclavian edge, leading edge after circles in the bun or spinous process before the trailing edge, in external canthus after 1.5cm, according to the nasal involvement including the nasal cavityThree dimensional conformal radiation therapy: using CT simulation location machine positioning, and then the physician drawing target outline, physics teacher using treatment planning system software for treatment planning, then the dose and location verification, initiation of treatment. The United States of America Varian linear accelerator radiotherapy using the 23EX of the 6 MV high energy X line and 9MeV line treatment.Two methods are used in conventional dose fractionation patterns, i.e. once a day, each 1.8～2.0Gy 5 times a week, the total of 65~75Gy irradiation method. Radical external beam radiotherapy nasopharyngeal zone should be 70 ~ 80Gy / 35-40 / 7-8 week. The irradiation dose of prophylactic neck is 50Gy. Metastasis of cervical lymph nodes should receive a total dose of 65 ~ 70Gy. Radiotherapy should be paid attention to tumors with shrinking to shrink irradiation field, in order to reduce normal tissue exposure. Radiotherapy should pay attention to important risk organs such as the brainstem and spinal cord protection, so that those volume is controlled in 40Gy2.2 Chemical treatmentConcurrent chemotherapy and radiotherapy is in in the process while giving chemotherapy regimens in 1 ~ 2 cycles,. In first days for the 1 cycle of radiotherapy [FP ] (5-fluorouracil + cisplatin)scheme. Usage: 5-FU 500mg / m2, Day 1 ~ Day 5, intravenous administration, DDP 70mg / m2 Day 1, intravenous administration. Cisplatin medication is given during hydration and diuretic. 1 cycles of chemotherapy is given 1 weeks before the end of Radiotherapy , 28 days for the 1 cycle of chemotherapy, a total of 6 cycle. Induction hemotherapy before radiotherapy, at first given to the 2 cycle of chemotherapy, 28 days for the 1 cycle of chemotherapy. Then the patients is gived the radical radiotherapy.After radiotherapy, chemotherapy is still needed according to 28 days, a total of 6 cycle. Radiotherapy plus adjuvant chemotherapy group was at the end of radiotherapy , thehemotherapy is given, for a total of 6 cycles of chemotherapy, scheme selection [FP ] (5-fluorouracil + cisplatin)plan.3. The staging criteria of nasopharyngeal carcinoma adopt international popular 2002UICC staging criteria4. outcome measures:the patient were followed-up since undiagnosed beginning on the date of the deadline to 2011 05 month 05 days, the entire group is followed-up ranged from 6 to 64 months, the median follow-up time is 44 months. Indicators of followed- up observation is the 5 year survival rate.5. Statistics: the income data were entred in Excel database, using SPSS12.0 statistical software for data processing. The count data is using x 2 test. The difference was statistically significant and Pair comparison is the t test, P < 0.05 that was statistically significant.Result1.The difference of sex and age on the impact of nasopharyngeal carcinoma prognosticThe study of 369 cases is male patients, female patients is 118 cases, men and women with ratio of 3.13: 1, the minimum age of the patients was 7 years, the highest is 81 years. Effects of 5 years survival rate of patients of the age effects are not significantly different, no statistical significance. 233 men who survive more than 5 years, the survival rate is 63.14%, 90 females survive for more than 5 years, the survival rate is 76.27 %. statistics is found that male patients 5 year survival rate was significantly lower in women.2. Different disease staging on the impact of nasopharyngeal carcinoma prognosticIn this study of 487 cases of nasopharyngeal carcinoma patients, stage T1was 99 cases, 95 cases survived for more than 5 years, the 5 year survival rate was 95.96%, stage T2 was 235 cases, 173 cases survive for more than 5 years, the 5 year survival rate reached 73.62%, stage T3 was 84 cases, 5 year survival cases was 29, the survival rate was 34.52%, T4 was 69 cases, survival cases was 27, 5 year survival rate was 39.68%. According to the clinical stage, 5 years survival rate of patients: stage I patients was 92%, stage II patients was 83.09%, patients with stageⅢwas 34.52%, stage IV patients was 37.68%. The results showed that 5 years survival rate of nasopharyngeal carcinoma was related with TNM staging, The higher of T, N and clinical staging ,the survival rate is lower.3. Different radiation therapy technology on the impact of nasopharyngeal carcinoma prognosticThis study compares the therapeutic effect of the classical conventional radiotherapy and three-dimensional conformal radiotherapy. The results showed that, 5 year survival rates of the conventional radiotherapy and three-dimensional conformal treatment group were 72.91% and 61.62%. The two groups were compared and 5 years survival rate of three-dimensional conformal treatment group, was significantly higher than that of the conventional treatment group (p < 0.05 ).4. Influence of different patterns of comprehensive treatment on prognosis of nasopharyngeal carcinomaWe also carried on the statistical analysis about nasopharyngeal carcinoma patients of 5 years survival rate using chemotherapy combining different integrated treatment mode. we accorded to chemoradiation for nasopharyngeal carcinoma with combination of different patterns, which is divided into induction chemotherapy combined with radiotherapy group, concurrent chemotherapy, radiotherapy and adjuvant chemotherapy group and mere radiotherapy. The results showed the 5 year survival rate in four groups were respectively 51.85%, 81.08%, 73.53%, 64.51%, the overall comparison of the 5 year survival rate is significantlyχ2 = 8.2448, p < 0.05 ). Compared with chemotherapy synchronous group and radiotherapy plus adjuvant chemotherapy grou ,Induction chemotherapy plus radiotherapy arep,χ2 = 6.2072, p< 0.05,χ2 = 4.1312, p< 0.05; Comparaed with radiotherapy alone group group,concurrent chemoradiotherapy(χ2= 4.1060, p<0.05) is Statistical significance. Concurrent chemoradiotherapy showed that a survival rate was significantly higher than that of induction chemotherapy, adjuvant chemotherapy treatment, radiotherapy alone group.Conclusion:1. The incidence of male patients with nasopharyngeal carcinoma was significantly higher than the females patients,and a better prognosis of females patients than male females2. the disease staging is an important factor affecting the prognosis of disease, the earlier the better outcome.3 .The dimensional conformal radiotherapy t is better than the conventional treatment .4. comprehensive treatment modality affects the prognosis of nasopharyngeal carcinoma... |
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