放化疗中不同化疗方式对N3期鼻咽癌预后影响  

Comparing treatment outcomes of different chemotherapy sequences during radio-chemotherapy for stage N3 nasopharyngeal carcinoma

作　　者：许婷婷[1] 胡超苏[1] 王孝深[1] 吴永如[1] 何霞云[1] 应红梅[1] 

机构地区：[1]复旦大学上海医学院肿瘤学系复旦大学鼻咽癌诊治中心复旦大学附属肿瘤医院放疗科,上海200032

出　　处：《中华放射肿瘤学杂志》2011年第3期181-185,共5页Chinese Journal of Radiation Oncology

摘　　要：目的评价放化疗中不同方式化疗对M期鼻咽癌患者预后的影响。方法回顾分析114例N3期鼻咽癌患者资料。9例接受单纯放疗；105例接受以铂类为基础化疗联合放疗，其中同期放化疗37例，诱导化疗＋同期放化疗53例，同期放化疗＋辅助化疗15例。鼻咽原发灶采用^60Co γ线、6MVX线常规分割照射70Gy，颈部根治量60-68Gy，颈部预防量54—60Gy。结果中位随访时间54个月，共51例患者死亡。全组5年总生存率为59．1％。单纯放疗、同期放化疗、诱导化疗＋同期放化疗、同期放化疗＋辅助化疗的5年总生存率分别为17％、51％、68％、71％（x2=15．44，P=0．001），无复发生存率分别为83％、77％、88％、93％（x2=2．34，P=0．505），无转移生存率分别为17％、54％、72％、80％（X2=19．28，P：0．000）。结论诱导化疗＋同期放化疗及同期放化疗＋辅助化疗方式对N1期鼻咽癌患者比单纯同期放化疗更具优势，最有效治疗方式有待随机研究证实。Objective Nasopharyngeal carcinoma patients with stage N3 disease are prone to develop distant metastasis even treated with standard concurrent chemoradiotherapy （CRT）. The aim of this study is to compare the efficacy of different chemotherapy sequences in these patients. Methods All patients with histologically proven, carcinoma of the nasopharynx treated between July 1999 and November 2003 were restaged according to the AJCC 2002 stage classification system. A total of 114 patients had AJCC N3 diseases were analyzed retrospectively. Patients were treated by conventional RT technique using 6 MV photons or 60Co3,_ray with 1.8 - 2. 0 Gy per fraction, 5 fractions a week, to a planned dose of 70 Gy. The prophylactic irradiation dose of the neck was 54 - 60 Gy. Any positive lymph node was boosted to a total dose of 60 - 68 Gy. All patients received cisplatin-based chemotherapy of different sequences but 9 patients received RT alone. CRT regimen was delivered in 37 patients, neoadjuvant chemotherapy （NACT） ＋ CRT regimen in 53 patients and CRT ＋ adjuvant chemotherapy （AC） regimen in 15 patients. Results The median follow up time was 54 months （3 -117months）. The 5-year overall survival rate was 59. 1% in whole groups, and with 17% , 51%, 68% and 71% in RT, CRT, NACT ＋ CRT and CRT ＋ AC group, respectively （X2 = 15.44,P =0. 001 ）. The 5-year relapse-free survival rates were 83%, 77% , 88% and 93% in RT,CRT,NACT ＋ CRT and CRT ＋ AC group, respectively （ X2 = 2. 34, P = 0. 505 ）. The 5-year metastasis-free survival rates were 17%, 54% , 72% and 80% in RT, CRT, NACT ＋ CRT and CRT ＋ AC group, respectively （ X2 = 19. 28, P = 0. 000）. Conclusions The NACT ＋ CRT and CRT ＋ AC regimens were more effective than CRT alone for N3 disease in the current study. Large prospective, randomized clinical studies are warranted.

关 键 词：鼻咽肿瘤/放化疗法 放化疗法 同期 放射疗法 常规分割 预后 

分 类 号：R739.63[医药卫生—肿瘤]