Ⅲ、Ⅳa期鼻咽癌调强放疗联合三种含铂方案同期化疗的比较  

The comparison of intensity modulated conformal radiotherapy with three platinum-based programs as concurrent chemotherapy for Ⅲ,IVa stage nasopharyngeal carcinoma

作　　者：许明君[1] 叶建明[1] 郭海亮[1] 黄莉[1] 王祥财[1] 

机构地区：[1]赣南医学院第一附属医院肿瘤科,江西省赣州市341000

出　　处：《实用医学杂志》2013年第4期622-624,共3页The Journal of Practical Medicine

基　　金：江西省卫生厅2008年科技计划项目(编号:2006021046)

摘　　要：目的:比较调强适形放疗(IMRT)联合顺铂+氟尿嘧啶(PF)、紫杉醇+顺铂(TP)、每周顺铂(DDP)方案同期治疗Ⅲ、Ⅳa期鼻咽癌的临床疗效和毒副反应。方法:采用前瞻、随机对照研究,138例Ⅲ、Ⅳa期初治鼻咽癌患者分别行PF、TP、每周顺铂方案同期放化疗。均采用IMRT放疗技术。结果:中位随访28(5～37)个月,三组无瘤生存曲线和生存曲线差异有统计学意义(P<0.05)。两两比较,DDP组与PF组优于TP组。三组Ⅲ～Ⅳ度粒细胞减少、胃肠道反应、口腔黏膜炎分别为34.78%vs30.43%vs8.70%(P<0.05)、23.91%vs21.74%vs34.78%(P<0.05)、60.87%vs65.22%vs52.17%(P>0.05)。结论:IMRT同期联合PF、TP、DDP方案治疗Ⅲ、Ⅳa期鼻咽癌,综合近期疗效与毒副反应,DDP方案最优,PF方案次之,远期疗效仍有待进一步随访观察比较。Objective To compare the clinic efficacy and toxicities of cisplatin plus fluorouracil （PF）, paclitaxel plus cisplatin （TP）or weekly cisplatin （DDP） concurrent chemotherapy with intensity modulated conformal radiotherapy （IMRT） in the treatment of patients with III,IVa stage nasopharyngeal carcinoma. Methods In the prospective randomized controlled trial, 138 newly diagnosed cases of III- IV a stage nasopharyngeal carcinoma patients were treated with PF,TP, weekly DDP concurrent chemotherapy respectively and all treated with IMRT. Results Within the median follow-up period of 28 （5-37）months, there were statistical significant differences of the tumor-free survival curves and survival curves in three groups（P 〈 0.05）. In the pairwise comparison, DDP and PF group were better than TP group. The occurrence of III-IV degree of granulocytopenia, gastrointestinal reactions and oral mueositis were 34.78% vs 30.43% vs 8.70% （P 〈 0.05）,23.91% vs 21.74% vs 34.78% （P 〈 0.05）,60.87% vs 65.22% vs 52.17% （P 〉 0.05）. Conclusion By analyzing short-term effects and toxic side effects comprehensivly,the DDP scheme was optimum, PF scheme was the next,but the long-term outcome still needed further observation.

关 键 词：鼻咽肿瘤 调强适形放射治疗 同期化疗 紫杉醇 顺铂 氟尿嘧啶 

分 类 号：R739.63[医药卫生—肿瘤]