调强放疗联合不同化疗方案治疗鼻咽癌的疗效比较  

Comparison of the Efficacy of IMRT combined with Different Chemotherapy in Nasopharyngeal Carcinoma

作　　者：魏锐文[1] 范敏[1] 

机构地区：[1]成都市第七人民医院耳鼻咽喉科,四川成都610041

出　　处：《四川医学》2015年第12期1654-1656,共3页Sichuan Medical Journal

摘　　要：目的评估两种治疗方案对伴有淋巴结转移的鼻咽癌患者的有效性及安全性。方法随机将76位患者(分期Ⅱb~Ⅳa-b)分为两组。A组治疗方案为:顺铂60mg/m^2,分2d静脉输入;5-氟尿嘧啶2500 mg/m^2,连续48h持续静脉泵入;吉西他滨:1000mg/m^2,d1、d8,共8周期,化疗结束后立即行调强放疗。B组治疗方案为:顺铂75mg/m^2,分3d静脉输入;5-氟尿嘧啶500mg/m^2,1~5 d。每21d化疗1次,放疗前化疗2次,化疗后立即行调强放疗,放疗结束1月后按相同方案行2次辅助化疗。所有患者均行调强放疗,原发肿瘤照射剂量为66~70Gy,转移淋巴结的照射剂量为66Gy,高危区照射剂量为60Gy,低危区照射剂量为55Gy。平均随访为24月。结果 A组患者的2年局部控制率、无远处转移生存率、总生存率分别为93.4%、94.1%、93.1%,B组患者的2年局部控制率、无远处转移生存率、总生存率分别为89.4%、85.6%、89.8%,两组比较差异均有统计学意义(P<0.05)。A组患者毒性反应较轻,B组患者毒性反应较重。结论顺铂、5-氟尿嘧啶及吉西他滨的联合化疗+调强放疗的治疗方案具有更好的治疗效果,毒性反应更小。Objective To evaluate the efficacy and safety of two treatment options for nasopharyngeal carcinoma（ NPC）patients with lymph node metastasis. Methods 76 patients were randomly（ stage Ⅱb ~ Ⅳa-b） divided into two groups. A group therapy program： cisplatin 60 mg / m^2,divided 2d infusion; 5-fluorouracil 2500mg/m^2,continuous 48 h continuous intravenous infusion; gemcitabine： 1000 mg / m2,d1,d8,after a total of 8 cycles chemotherapy IMRT carried out immediately. Group B treatment program： cisplatin 75 mg / m^2,divided 3d infusion; 5-fluorouracil 500mg/m^2,1 ~ 5 d. 21 d chemotherapy every 1,2 times before radiotherapy,IMRT carrid out immediately after chemotherapy,after the end of month of radiotherapy implemented twice of the same program of adjuvant chemotherapy. All patients underwent IMRT,the primary tumor irradiation dose of 66 ~ 70 Gy,lymph node irradiation dose of 66 Gy,high-risk areas as radiation dose 60 Gy,low-risk area of irradiation dose of 55 Gy. Mean follow-up was 24 months. Results 2-year local control distant metastasis-free survival,overall survival rates were 93. 4%,94. 1%,93. 1%,respectively. 2-year local control rate of group B patients distant metastasis-free survival,overall survival rates were 89. 4%,85. 6%,89. 8%,respectively. the differences were statistically significant（ P〈0. 05）. A group of patients with mild toxicity reaction was gently in group B reaction. Conclusion Cisplatin,5-fluorouracil and gemcitabine combination chemotherapy ＋ IMRT treatment regimen has better therapeutic effect,little toxicity.

关 键 词：顺铂 吉西他滨 5-氟尿嘧啶 调强放疗 鼻咽癌 

分 类 号：R739.63[医药卫生—肿瘤]