动脉灌注化疗联合调强放疗治疗局部晚期鼻咽癌的远期疗效  

Long Term Effect of Intra-arterial Chemotherapy Combined with Intensity-Modulated Radiotherapy on Locally Advanced Nasopharyngeal Carcinoma

作　　者：陈建武[1] 张幸平[2] 刘德鑫[3] 汪茜[1] 吴丽芳[1] 

机构地区：[1]福建医科大学附属第二医院放疗科,泉州362000 [2]重庆医科大学附属第一医院肿瘤科,重庆400016 [3]福建医科大学附属第二医院放射科,泉州362000

出　　处：《福建医科大学学报》2015年第4期231-235,共5页Journal of Fujian Medical University

基　　金：福建省自然科学基金(2011J01155);福建省医学创新课题(2009cx-10)

摘　　要：目的探讨动脉灌注化疗联合调强放疗治疗局部晚期鼻咽癌的远期疗效。方法选择首诊的局部晚期(T3T4和/或N2N3)鼻咽癌患者120例,分2组治疗:(1)动脉灌注给药放化疗60例(IAC组):先用多西他赛60~75mg/m^2 d1+顺铂75mg/m^2 d1,动脉灌注给药,21d为1个周期,连续使用2个周期,之后予以根治性同步放化疗,于放疗第1,22,43d同步使用顺铂75mg/m^2动脉灌注给药;(2)对照组60例:化疗方案同IAC组,静脉给药。所有病例均接受根治性调强放疗。采用Kaplan-Meier及Log-rank法计算和比较2组患者的生存率,Cox比例风险模型多变量分析生存相关影响因素。结果 (1)全组(IAC组+对照组)3年及5年总生存率(OS)分别为77.83%,62.35%。IAC组及对照组的3年OS分别为86.72%,72.13%,5年OS分别为78.85%,60.21%(P<0.05)。(2)IAC组及对照组的3年无病生存率(DFS)分别为78.64%,56.21%,5年DFS分别为66.73%,50.12%(P<0.05)。(3)远期并发症主要表现为1,2级口干及感音性耳聋;IAC组与对照组口干发生率为51.7%和48.3%,感音性耳聋为53.3%和56.7%,差别均无统计学意义。(4)主要失败原因为局部/区域复发及远处转移,IAC组与对照组的总失败率及局部/区域复发率为35.0%和68.3%(P<0.05)及6.7%和38.3%(P<0.05)。(5)Cox比例风险模型多变量分析提示影响患者生存的因素有:T分期、N分期、化疗给药途径、放疗剂量、血色素下降(≤80g/L)、体质量下降(≥10%)。结论动脉灌注化疗联合调强放疗治疗局部晚期鼻咽癌远期临床疗效明显,使用安全,值得进一步加大病例数随机对照研究。Objective To explore long term effect of arterial perfusion chemotherapy combined with Intensity-Modulated Radiotherapy（IMRT） on patients with Locally Advanced Nasopharyngeal Carei- noma（LANC）. Methods 120 cases of LANC （T3 T4 and /or N2 N3） first treated in our hospital were studied from January 2008 to June 2010. The experimental group（IAC group, intra-arterial chemo-radio- therapy,60 cases）was given two cycles induction chemotherapy, using intra-arterial infusion of docetaxel, 60- 75 mg/m2 , and cisplatin, 75 mg/m2 on day 1, every 3 weeks followed by concurrent chemo-radiotherapy with cisplatin, 75 mg/m2 , day 1,22, and 43. The control group （ 60 cases） received the same scheme of chemotherapy as IAC, but intravenous administration. All received radical IMRT. The survival rates were analyzed and compared by Kaplan Meier and Log-rank. The survival related factors were analyzed by Cox proportional hazard model for multivariate analysis. Results （1） 3-year and 5-year overall survival（OS）of the whole group（IAC＋control group） was 77.83%, 62.35%, respectively. 3-year OS in IAC and control group was 88. 72%,72. 13%, and 5-year OS was 78. 85%, 80. 21%, respectively, P〈0.05. （2） 3-year disease-free survival（DFS） in IAC and control group was 78.64%, 56.21%, and 5-year DFS was 66.73%, 50.12%, respectively, P〈0.05. （3）The long term complications were mainly mainly 1/2 degree of dry mouth and sensory deafness. The incidence of dry mouth in IAC and control group was 51.70% and 48.3%, respectively,P〈0.05; and the rate of sensory deafness between the two group was 53.3% vs 56.7%,P〈0. 05, both without statistical significance. （4） Local/regional recurrence and metastasis were the main failure causes. The total failure rate and local/regional recurrence rate of IAC group was significantly lower than that in control group, 36.0% vs 68.0% （P%0.05） and 8.0%o vs 38.0% （P〈0.05）, respectively. （5） Cox proportional hazard model for multivariate analysis

关 键 词：动脉 输注 动脉内 药物疗法 联合 鼻咽肿瘤 治疗效果 

分 类 号：R739.63[医药卫生—肿瘤]