调强放疗联合化疗对局部晚期鼻咽癌的临床研究  

Clinical study of intensity-modulated radiotherapy combined with chemotherapy for locally advanced nasopharyngeal carcinoma

作　　者：徐莹[1] 郭占文[1] 阎英[1] 张海波[1] 

机构地区：[1]解放军沈阳军区总医院肿瘤放疗科,110016

出　　处：《中国临床实用医学》2016年第1期12-14,共3页China Clinical Practical Medicine

摘　　要：目的探讨局部晚期鼻咽癌调强放疗联合化疗与单纯调强放疗的疗效及其毒副反应。方法回顾性分析自2008年1月至2015年1月间在沈阳军区总医院接受初次治疗的鼻咽癌患者共59例，病理为低分化鳞癌，将其分为单放组24例与放疗加化疗组（放化组）35例，均采用调强放射治疗技术放疗。照射剂量：（GTVnx，GTVnd为64—72Gy，CTV1为58—60Gy，CTV2为50-54Gv，共28。32次，1次／d，5次／周。放化组中放疗第1天给予多西他赛60-75mg／m^3，d1，奈达铂30-40mg，d1-d3，间隔21d为1个周期，放疗期间完成2个周期化疗，放疗结束后序贯化疗3。4个周期。采用Kaplan—Meier法分析生存率，RTOG／EORTC标准评价毒副反应。结果全组中位随访时间为26．6个月，单放组和放化组1、3、5年生存率分别为95．9％Vs100．0％（P〉0．05）、82．9％Vs91．4％（P〈0．05）及79．2％Vs88．9％（P〈O．05）。局部控制率分别为97．2％Vs98．8％、93．2％Vs95．3％及84．1％Vs90．3％。局部控制率两组间差异无统计学意义（P〉0．05）。远处转移率分别为37．5％Vs22．8％（P〈0．01）。多数患者为1-2级放化疔毒性反应和0-1级晚期损伤，两组间差异无统计学意义（P〉0．05）。未观察到4级及以上毒副反应和晚期损伤。结论多西他赛联合奈达铂同步放化疗后序贯化疗可以提高局部晚期鼻咽癌3、5年生存率，降低远处转移率，其血液学毒性反应及消化道毒性反应较轻，患者可以耐受，是局部晚期鼻咽癌可行的治疗方案。Objective Analysis of combined treatment and IMRT alone in the therapy of loco- regionally advanced nasopharyngeal carcinoma from the aspect of therapeutic effect and adverse effect. Methods 59 patients with loco-regionally advanced nasopharyngeal carcinoma, diagnosed as poorly differentiated squamous cell carcinoma, were evaluated in this study. 24 treated only with radiotherapy grouped as R, while 35 treated with combined treatment of radiotherapy and chemotherapy grouped as C. All the patients received intensity modulated radiation therapy（IMRT） with dose as follows： GTVnx 64-72 Gy/ 28-32fractions, GTVnd 64-72 Gy/28-32 fractions, CTV1 58-60 Gy/28-32 fractions, CTV2 50-54 Gy/28- 32, 5 fractions/week. Chemotherapy was administrated as docetaxel 60-75mg/m^3, VD dl, and nedaplatin 30-40rag, VD d1-3. The chemotherapy was given 21 days per cycle for 2cycles during radiotherapy and 3-4 cycles after radiotherapy, which was initiated identically at the day with radiotherapy. Kaplan-Meier method was adapted here to analyze survivals. The acute and late radiation toxicities were evaluated based on the toxicity criteria of RTOG/EORTC. Results With a median follow-up period of 26.6 months, the overall cumulative 1-, 3- and 5-year survival rates of group R versus group C were 95.9%Vs100% （P 〉0.05 ） ,82.9%Vs91.4%（P〈0.05）,and 79.2%Vs88.9%（P〈0.05）, respectively. The locally reoccurrence- free probability of group R versus group C were 97.2%Vs98.8%P〉0.05 ） , 93.2%Vs95.3% （ P〉0.05 ） , and 84.1%Vs90.3%（P〉0.05）, which was not statistically significant. The distant metastasis rates of group R versus group C were 37.5%Vs22.8 % （P〈0.01）. Most patients developed grade 1-2 acute radiation toxicities and grade 0-1 late radiation toxicities. However, there is no statistically difference between the two groups（P〉0.05）. No patient developed grade 4 acute or late toxicity. Conclusions With a higher 3-, and 5-year survival rate and a lower distant metastasis rate, combined treatment of chem

关 键 词：鼻咽肿瘤 调强放射治疗 化学治疗 生存分析 毒副反应 

分 类 号：R739.63[医药卫生—肿瘤]