局部晚期鼻咽癌73例放化疗综合治疗的临床研究  

Clinical study of 73 local-advanced nasopharyngeal carcinoma patients treated with chemoradiotherapy

作　　者：张学成[1] 石梅[1] 肖锋[1] 魏立春[1] 孙朝阳[1] 朱勇[1] 陆军[1] 刘晓莉[1] 

机构地区：[1]第四军医大学西京医院放疗科,陕西西安710032

出　　处：《中华肿瘤防治杂志》2007年第22期1710-1713,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:回顾性分析两种不同的放化疗综合治疗方案对局部晚期鼻咽癌的临床疗效、急性反应和晚期损伤。方法:初治鼻咽癌患者73例,分为常规放疗加化疗综合治疗组(RT+CT)42例和调强放疗加化疗组(IMRT+CT)31例。常规放疗鼻咽部剂量70～76Gy,肿大淋巴结60～65Gy,颈部预防剂量50Gy;调强放疗设鼻咽部大体肿瘤为GTVnx、颈部阳性淋巴结GTVnd、高危临床靶体积CTV1和低危临床靶体积CTV2。处方剂量分别为GTVnx(70.6～76.6)Gy/(31～33)f、GTVnd(61.6～70.6)Gy/(28～33)f、CTV156Gy/28f、CTV2(50.4～53.2)Gy/28f,化疗方案包括诱导、同期与辅助。结果:中位随访时间20个月,全组2年和3年的局部区域无复发率、无远处转移生存率及总生存率分别为83.3%、90.9%、86.2%和78.9%、89.5%、84.3%;(RT+CT)组分别为70.0%、85.0%、77.6%和70.0%、80.6%、60.4%;(IMRT+CT)组分别为88.9%、95.5%、100%和88.9%、95.5%、100%。Log-rank生存比较显示,(RT+CT)组与(IMRT+CT)组的局部区域无复发率与总生存率比较差异有统计学意义,P值分别为0.045和0.021。结论:IM-RT加化疗对局部晚期鼻咽癌可获得理想的局部区域控制和总生存率。OBJECTIVE： To present preliminary results of two different chemoradiotherapy schemes in patients with nasopharyngeal carcinoma and to observe the acute and late normal tissue toxicities. METHODS： There were 73 patients with nasopharyngeal carcinoma. All the patients were divided into 2 groups, （RT＋CT） group 42 cases, and （IMRT＋CT） group 31 cases. For conventional radiation technique, the prescription dose to the target was （70-76） Gy. For IMRT, the prescription dose was engaged to the gross tumor volume （GTVnx） of nasopharyngeal to D;（70. 6-76. 6） Gy/（31-33） f, positive neck lymph nodes （GTVnd） to D;（61. 6-70. 6） Gy/（28-33） f,clinical target volume high risk （CTV1） to 56 Gy/28 f, and low risk（CTV2） to （50.4-53.2） Gy/28 f. The chemotherapy was included induction, concomitant and adjuvant protocol. RESULTS： With a median followed-up of 20 months. In all patients, the 2-, 3-year estimated local-regional progression-free survival rates, distant metastases-free survival rates and overall survival rates were 83.3%, 90.9%, 86.2% and 78.9%, 89.5%, 84. 3%, respectively. In （RT＋CT） group, they were 70.0%, 85.0%, 77.6% and 70.0%, 80.6%, 60.4%, respectively. In （IMRT＋CT） group, they were 88.9%, 95.5%, 100% and 88.9%, 95.5%, 100%, respectively. （IMRT＋ CT） group had significantly higher localregional progression-free survival rate and overall survival rate than （RT＋CT） group（P=0.045, P=0.021）. CONCLUSION： IMRT combined with chemotherapy can improve local-regional progression-free survival rate and overall survival rate of patients with local-advanced nasopharyngeal carcinoma.

关 键 词：鼻咽肿瘤/放射疗法 鼻咽肿瘤/化学疗法 预后 回顾性研究 

分 类 号：R739.63[医药卫生—肿瘤]