鼻咽癌前组筛窦侵犯诱导化疗结合混合线放射治疗模式的探讨  

Exploration of induction chemotherapy combined mixed beams radiation for nasopharyngeal carcinoma with anterior ethmoid sinus invasion

作　　者：谢松喜[1] 林映如[1] 曾子君[1] 李伟雄[1] 

机构地区：[1]广东省人民医院肿瘤中心放疗科,广州510080

出　　处：《重庆医学》2007年第14期1398-1399,共2页Chongqing medicine

摘　　要：目的初步探讨诱导化疗结合混合线照射治疗鼻咽癌筛窦侵犯的可行性。方法共16例鼻咽癌患者入组,每个患者先行2个疗程诱导化疗,方案采用CF 120mg/m2,5-FU 400mg/m2,1～5d,DDP 70mg/m2,1d,常规行止吐和水化处理,每3周重复。放疗采用双侧野,矩形野挡眼球和晶体,6MV的X线照射,剂量70～72Gy.(35～36次)-1.(7周)-1。筛窦前采用电子线照射,根据深度选择电子线的能量级,剂量60Gy.(30次)-1.(6周)-1。化疗后和放疗后复查鼻咽CT和MRI,评价疗效,观察化疗和放疗毒性。结果16例患者全部完成诱导化疗和放疗,放疗后2个月复查CT和MRI,评价疗效鼻咽筛窦肿物完全消退8例(50.0%),部分消退7例(43.8%),稳定1例(6.2%),有效率为93.8%。Ⅱ级白细胞下降2例,Ⅲ级白细胞下降1例,筛窦前野照射野皮肤出现Ⅰ级放射性皮炎14例,Ⅱ级2例,未见有≥Ⅲ级的放射性皮炎。结论采用诱导化疗结合混合线照射治疗鼻咽癌前组筛窦侵犯是简单可行的。远期疗效和毒性需要进一步观察。Objective To preliminarily evaluate the feasibility of induction chemotherapy combined mixed beams radiation for nasopharyngeal carcinoma With anterior ethmoid sinus invasion. Methods Total 16 patients were enrolled, two courses of induction chemotherapy were administered with a plan consisted of CF 120mg/m^2 , 5-FU 400mg/m^2 , 1-5d, DDP 70mg/m^2 ,1d,1 week and 4 week, a protocol-mandated hydration and polyantiemetie regimen were used for all patients. The nasopharynx were treated via bilateral opposed fields and 6MV X beam, delivered up to a dose of 70-72Gy/35-36fractions/7weeks, eyeballs and crystals were sheltered with rectangular lead-blocker. Anterior emthoid sinus was administered with electron beams and a dose of 60Gy/ 30fractions/6weeks, the grade of beam energy was selected according the degree of depth. Nasopharynx CT and MRI were performed after chemotherapy and radiotherapy to evaluate the efficacy and toxicity. Results All patients received two courses of induction chemotherapy and radiotherapy. Eight of 16 patients checked by CT and MRI scans two months after radiotherapy showed CR（50.0%）, 7 patients achieved PR（43.8%）, and one patient was classed with SD（6.2%）, response rate was 93.8%. Grade Ⅱ and Ⅲ leucopenia were observed in 2 patients and 1 patient, respectively. Grade Ⅰradiation-induced dermatitis was observed in 14 patients, grade Ⅱ in 2 patients, without grade m and higher dermatitis. Conclusion The treatment of induction chemotherapy combined mixed beams radiation for nasopharyngeal carcinoma with anterior ethmoid sinus invasion is simple and feasible. The long-term benefits and toxicities will be observed further.

关 键 词：鼻咽癌 化疗 放射治疗 综合治疗 筛窦 

分 类 号：R739.63[医药卫生—肿瘤]