摘要:
Objective To compare the efficacy and adverse reactions of large segmentation gamma knife and large segmentation conformal retransmission radiotherapy for locally recurrent nasopharyngeal carcinoma. Methods One hundred and twenty- one patients with locally recurrent nasopharyngeal carcinoma from January 2009 to June 2012 were selected. The patients were divided into large segmentation conformal retransmission radiotherapy group (control group, 61 cases) and large segmentation gamma knife retransmission radiotherapy group (study group, 60 cases) according to the propensity score matching method. The radiation injury, quality of life, short-term efficacy and long-term efficacy were observed. Results In the recent radiation injury, the incidences of maxillofacial skin reaction and fatigue in study group were significantly higher than those in control group: 28.3% (17/60) vs. 13.1% (8/61) and 48.3% (29/60) vs. 29.5% (18/61), and there were statistical differences (P0.05). In the long-term radiation injury, the incidences of deafness and difficulty in opening mouth in study group were significantly lower than those in control group: 33.3% (20/60) vs. 52.5%(32/61) and 58.3% (35/60) vs. 73.8% (45/61), the incidence of maxillofacial muscle fibrosis in control group was significantly higher than that in control group: 43.3% (26/60) vs. 26.2% (16/61), and there were statistical differences (P0.05). In the actual long- term radiation injury, the incidences of dry mouth, deafness and difficulty in opening mouth in study group were significantly lower than those in control group: 66.7% (40/60) vs. 86.9% (53/61), 31.7% (19/60) vs. 50.8% (31/61) and 43.3% (26/60) vs. 67.2% (41/61), the incidence of maxillofacial muscle fibrosis in study group was significantly higher than that in control group: 41.7% (25/60) vs. 23.0% (14/61), and there were statistical differences (P0.05). There were no significant differences in Karnofsky performance scale (KPS) score and body weight change before treatment and at the end of treatment, and at the end of treatment and 3 months after treatment between 2 groups (P > 0.05). For the short-term efficacy, the local control rates of 3, 6, 9 and 12 months after treatment in study group were significantly higher than those in control group: 75.0% (45/60) vs. 54.1% (33/61), 86.7% (52/60) vs. 62.3% (38/61), 90.0% (54/60) vs. 67.2% (41/61) and 91.7% (55/60) vs. 68.9% (42/61), and there were statistical differences (P 0.05). Conclusions Large-segment gamma knife and large-segment conformal reconstitution radiotherapy are effective for the short-term curative effect and long-term curative effect of locally recurrent nasopharyngeal carcinoma. They can reduce radiation damage and have better safety. Large segmentation gamma knife reconstitution radiotherapy is more advantageous in reducing the long- term radiation injury and improving the local control than large segmentation conformal retransmission radiotherapy.%目的 比较大分割伽马刀与大分割适形再程放疗治疗局部复发鼻咽癌的疗效和不良反应.方法 选取2009年1月至2012年6月收治局部复发鼻咽癌患者121例,倾向性得分匹配法分为大分割适形再程放疗组(对照组,61例)和大分割伽马刀再程放疗组(研究组,60例).观察放射损伤、生命质量影响、近期疗效及远期疗效等.结果 近期放射损伤,研究组颌面部皮肤反应和乏力发生率明显高于对照组[28.3%(17/60)比13.1%(8/61)和48.3%(29/60)比29.5%(18/61)],差异有统计学意义(P0.05).远期放射损伤,研究组耳聋和张口困难发生率明显低于对照组[33.3%(20/60)比52.5%(32/61)和58.3%(35/60)比73.8%(45/61)],而颌面部肌肉纤维化发生率明显高于对照组[43.3%(26/60)比26.2%(16/61)],差异有统计学意义(P0.05).实际远期放射损伤,研究组口干、耳聋和张口困难发生率明显低于对照组[66.7%(40/60)比86.9%(53/61)、31.7%(19/60)比50.8%(31/61)和43.3%(26/60)比67.2%(41/61)],而颌面部肌肉纤维化发生率明显高于对照组[41.7%(25/60)比23.0%(14/61)],差异有统计学意义(P0.05).两组治疗前与治疗结束时及治疗结束时与治疗后3个月KPS评分、体质量变化比较差异无统计学意义(P>0.05).近期疗效,研究组治疗后3、6、9和12个月局部控制率明显高于对照组[75.0%(45/60)比54.1%(33/61)、86.7%(52/60)比62.3%(38/61)、90.0%(54/60)比67.2%(41/61)和91.7%(55/60)比68.9%(42/61)],差异有统计学意义(P0.05).结论 大分割伽玛刀与大分割适形再程放疗用于局部复发鼻咽癌患者的近期疗效、远期疗效较好,可减少放射损伤,安全性较好;大分割伽马刀再程放疗比大分割适形再程放疗在降低远期放射损伤和提高局部控制上更有优势.