儿童及青少年鼻咽癌的放射治疗及临床效果分析
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摘要
目的探讨儿童及青少年鼻咽癌的临床特点、治疗、预后及并发症。方法回顾性分析53例儿童及青少年(≤20岁)鼻咽癌患者的临床资料。结果首发症状以颈部肿块和鼻部症状(血涕、鼻塞)最多见,分别占60.4%和20.7%,多数被误诊为颈部淋巴结炎、淋巴结结核、鼻炎、中耳炎。53例均为首次放射治疗,其中有7例因鼻咽部和颈部复发及3例颈部复发者行第二次放射治疗,照射剂量鼻咽部57~69 gy,颈部60~75 gy,常规分割外照射。22例配合化疗(PBF或PFA方案3~5周期)。放疗后鼻咽部和颈部均有复发7例,单纯颈部复发3例。5年生存率73.6%(39/53),II期5年生存率88.2%(15/17),III期及IV期66.7%(24/36)。远地转移11例(占20.8%),其中肺转移3例、全身多处骨转移6例、肝转移2例(均存活不满5年)。放射治疗后遗症主要为龋齿18.0%、颈部软组织纤维化18.0%、记忆力下降13.6%、听力下降9.0%、生长发育迟缓9.0%、张口困难4.5%、语音不清4.5%等。结论儿童及青少年鼻咽癌患者具有发病率低、病期偏晚、预后较好的特点。放射治疗效果较好,早期放射反应出现的比例高、时间早。治疗失败出现远处转移后,继续予以相应的治疗,仍可取的较好的疗效。
Objective To investigate the clinical characteristics,treatment,prognosis and complications of nasopharyngeal carcinoma in children and adolescents. Methods Clinical data of 53 children and adolescents( ≤ 20 years) with nasopharyngeal carcinoma were retrospectively analyzed. Results The most common first symptoms were neck mass and nasal symptoms( blood tears and nasal congestion) that accounted for 60. 4% and 20. 7%,respectively. The majority of patients were misdiagnosed as cervical lymphadenitis,lymph node tuberculosis,rhinitis or otitis media. All the patients had the first radiotherapy. There were 7 cases of the nasopharynx and neck recurrence and 3 cases of recurrence undergoing a second neck radiotherapy. The radiation doses were nasopharynx 57 ~69 gy and neck 60 ~ 75 gy with conventional split external irradiation. There were 22 cases combining with chemotherapy( PBF or PFA program from 3 to 5 cycles). There were 7 cases having nasopharynx and neck recurrence and 3 cases having simple neck recurrence after radiotherapy. The average 5-year survival rate was 73. 6%,stage II 88. 2% and stage III /IV 66. 7%. Distant metastasis was found in 11 patients( 20. 8%),including lung metastases in 3 cases,systemic multiple bone metastases in 6 cases and liver metastases in 2cases. Their mean survivals were less than 5 years. Radiotherapy sequelas included dental caries( 18. 0%),neck soft tissue fibrosis( 18.0%),memory loss( 13.6%),hearing loss( 9.0%),growth retardation( 9.0%),trismus( 4.5%) or unclear voice( 4.5%). Conclusion Children and adolescents with nasopharyngeal carcinoma have characteristics of low incidence,later stage of disease and better prognosis. Radiation therapy has a good effect and a high percentage of early radiation reactions. Distant metastasis could happen if treatment was failure. A better outcome could be obtained if further appropriate treatment is taken.
Objective To investigate the clinical characteristics,treatment,prognosis and complications of nasopharyngeal carcinoma in children and adolescents. Methods Clinical data of 53 children and adolescents( ≤ 20 years) with nasopharyngeal carcinoma were retrospectively analyzed. Results The most common first symptoms were neck mass and nasal symptoms( blood tears and nasal congestion) that accounted for 60. 4% and 20. 7%,respectively. The majority of patients were misdiagnosed as cervical lymphadenitis,lymph node tuberculosis,rhinitis or otitis media. All the patients had the first radiotherapy. There were 7 cases of the nasopharynx and neck recurrence and 3 cases of recurrence undergoing a second neck radiotherapy. The radiation doses were nasopharynx 57 ~69 gy and neck 60 ~ 75 gy with conventional split external irradiation. There were 22 cases combining with chemotherapy( PBF or PFA program from 3 to 5 cycles). There were 7 cases having nasopharynx and neck recurrence and 3 cases having simple neck recurrence after radiotherapy. The average 5-year survival rate was 73. 6%,stage II 88. 2% and stage III /IV 66. 7%. Distant metastasis was found in 11 patients( 20. 8%),including lung metastases in 3 cases,systemic multiple bone metastases in 6 cases and liver metastases in 2cases. Their mean survivals were less than 5 years. Radiotherapy sequelas included dental caries( 18. 0%),neck soft tissue fibrosis( 18.0%),memory loss( 13.6%),hearing loss( 9.0%),growth retardation( 9.0%),trismus( 4.5%) or unclear voice( 4.5%). Conclusion Children and adolescents with nasopharyngeal carcinoma have characteristics of low incidence,later stage of disease and better prognosis. Radiation therapy has a good effect and a high percentage of early radiation reactions. Distant metastasis could happen if treatment was failure. A better outcome could be obtained if further appropriate treatment is taken.
引文
[1]刘菊英,魏宝清.145例儿童及青少年鼻咽癌临床与疗效分析[J].中华放射肿瘤学杂志,2003,4:234-237.
[2]Jouhadi H,Sahraoui S,Acharki A,et al.Is chemoradiation feasible for child nasopharyngeal carcinoma[J].J Clinl Oncol,2005,23(16s):8558.
[3]Zubizarreta PA,DAntonio G,Raslawski E,et al.Nasopharyngeal carcinoma in childhood and adolescence[J].Cancer,2000,89(3):690-695.
[4]Mertens R,Granzen B,Lassay L,et al.Nasopharyngeal carcinoma in childhood and adolescence:concept and preliminary results of the cooperative GPOH study NPC-91[J].Cancer,1997,80(5):951-959.
[5]许昌韶,殷蔚伯,田野,周菊英.肿瘤放射治疗学[M].第2版.苏州大学出版社,2005:252.
[6]陈建武,潘建基,林少俊,等.儿童鼻咽癌远期疗效分析[J].现代肿瘤学,2007,15(10):1406-1409.
[2]Jouhadi H,Sahraoui S,Acharki A,et al.Is chemoradiation feasible for child nasopharyngeal carcinoma[J].J Clinl Oncol,2005,23(16s):8558.
[3]Zubizarreta PA,DAntonio G,Raslawski E,et al.Nasopharyngeal carcinoma in childhood and adolescence[J].Cancer,2000,89(3):690-695.
[4]Mertens R,Granzen B,Lassay L,et al.Nasopharyngeal carcinoma in childhood and adolescence:concept and preliminary results of the cooperative GPOH study NPC-91[J].Cancer,1997,80(5):951-959.
[5]许昌韶,殷蔚伯,田野,周菊英.肿瘤放射治疗学[M].第2版.苏州大学出版社,2005:252.
[6]陈建武,潘建基,林少俊,等.儿童鼻咽癌远期疗效分析[J].现代肿瘤学,2007,15(10):1406-1409.
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