放射治疗联合烟酰胺和Carbogen治疗鼻咽癌的临床初步研究  

Preliminary Study of Conventional Radiotherapy Combined with Nicotinamide and Carbogen in the Treatment for Nasopharyngeal Carcinoma

作　　者：陆雪官[1] 胡超苏[1] 王孝深[1] 沈春英[1] 冯炎[1] 

机构地区：[1]复旦大学附属肿瘤医院

出　　处：《肿瘤学杂志》2007年第5期359-362,共4页Journal of Chinese Oncology

摘　　要：[目的]对鼻咽癌病例采用常规分割放射治疗(CRT)联合Carbogen(CB)和/或烟酰胺(NAM)的治疗,探讨该治疗方案的可行性、毒性反应和初步疗效。[方法]1999年9月至2001年6月间共有60例初次治疗的鼻咽低分化鳞癌病例入组。所有病例被分成3组,每组均为20例,分别是放疗+烟酰胺组(CRT+NAM组)、放疗+Carbogen组(CRT+CB组)和放疗+烟酰胺+Carbogen组(CRT+NAM+CB组)。在鼻咽原发病灶每次照射前60min,口服烟酰胺片50mg/kg。在鼻咽癌原发病灶每次照射前4min到治疗结束的过程中吸入Carbogen。[结果]所有病例按计划完成了常规放射治疗,CRT+CB和CRT+NAM+CB两组的40例病人均完成了Carbogen的吸入,而CRT+NAM和CRT+NAM+CB组的40例中有5例中断服用烟酰胺。CRT+NAM、CRT+CB和CRT+NAM+CB组的Ⅲ级急性口腔黏膜反应发生率分别为40%、30%和50%(P=0.822),Ⅲ级急性皮肤反应发生率分别为20%、25%和35%(P=0.571);CRT+NAM和CRT+NAM+CB组各有4例(20%)发生Ⅲ级胃肠道反应,而CRT+CB组无1例发生(P=0.000);骨髓、心脏、肝脏和肾脏的毒性反应发生率低,且程度较轻。所有病例的5年总生存率和局部控制率分别为82.8%和88.8%。CRT+NAM、CRT+CB和CRT+NAM+CB组的5年总生存率分别为77.1%、85%和85%(χ2=0.24,P=0.887),局部控制率分别为79%、93.8%和95%(χ2=3.68,P=0.159)。[结论]应用烟酰胺和Carbogen作为放射增敏剂联合常规分割放射治疗鼻咽癌的耐受性较好,并且治疗疗效比较满意,值得进一步研究。[Purpose] To assess the feasibility, toxicity, and primary clinical effect of combined conventional radiotherapy （CRT） with nicotinamide（NAM） and/or carbogen（CB） in the treatment for nasopharyngeal carcinoma （NPC）. [ Methods ] From September 1999 to June 2001, sixty initially treated patients with nasopharyngeal low differentiated squamous cell carcinoma were divided into 3 groups. Twenty patients received CRT with NAM （CRT＋NAM）, 20 received CRT with CB （CRT＋CB） and 20 were treated with CRT＋NAM＋CB. NAM at the dose of 50mg/kg was administered orally 60 min before each irradiation to primary tumor. CB inhale commenced 4min before primary tumor irradiation and continued throughout the whole irradiation. [ Results ] The planned treatment including CRT and CB inhale was administered without any interrupt. Five of the 40 patients who received NAM were unable to continue on NAM intake during the entire treatment period. The incidence of grade Ⅲ oral mucositis in CRT＋NAM, CRT＋CB and CRT＋NAM＋CB groups were 40%, 30% and 50%, respectively （P=0.822）. Grade Ⅲ acute skin toxicity was observed in 20% of patients in CRT＋NAM, 25% in CRT＋CB and 35% in CRT＋NAM＋CB（P=0.571）. Grade Ⅲ gastrointestinal toxicity appeared in 20% of patients in CRT＋NAM and CRT＋NAM＋CB group similarly, but no one in CRT＋CB group （P=0.000）. The incidence and toxicity intensity of bone marrow, heart, liver and kidney acute toxicity were low in all patients. The overall survival rate （OSR） and local control rate （LCR） at 5-year were 82.8% and 88.8%, respectively. Five-year OSR were 77.1%, 85% and 85% in CRT＋NAM, CRT＋CB and CRT＋NAM＋CB （Χ^2=0.24,P= 0.887）, and LCR were 79.0%, 93.8% and 95.0% （Χ^2=3.68,P=0.159）, respectively. [Conclusion] Radiosensitizer NAM and/or CB combined with CRT for NPC is feasible with acceptable toxicity and the clinical effect is satisfied.

关 键 词：鼻咽肿瘤 放射疗法 烟酰胺 CARBOGEN 

分 类 号：R739.63[医药卫生—肿瘤]