调强放疗模式下局部晚期鼻咽癌诱导化疗后同期化疗与单纯放疗疗效比较  

Intensity modulated radiation therapy (IMRT) in the treatment mode for locally advanced nasopharyngeal carcinoma after induction chemotherapy of concurrent chemotherapy versus radiotherapy

作　　者：张晓军[1] 楚建军[1] 王明智[1] 张福正[1] 王震吾[1] 周乐源[1] Zhang Xiaojun Chu Jianjun Wang Mingzhi Zhang Fuzheng Wang Zhenwu Zhou Leyuan(Department of Tumor Radiotherapy,Affiliated Hospital of Jiangnan University（ Wuxi Fourth Hospital）, Jiangsu Wuxi 214062, China.)

机构地区：[1]江南大学附属医院(无锡第四人民医院)肿瘤放疗科,江苏无锡214062

出　　处：《现代肿瘤医学》2016年第23期3720-3724,共5页Journal of Modern Oncology

基　　金：无锡市医院管理中心重点课题(编号:YGZXL1314)

摘　　要：目的：探讨调强放疗模式下局部晚期鼻咽癌诱导化疗后同期化疗与单纯放疗临床疗效的比较。方法：回顾性分析2010年-2012年期间在本院采用调强放疗技术治疗的局部晚期鼻咽癌,分期为Ⅲ-Ⅳ期的鼻咽癌患者共120例。所有患者都进行过诱导化疗。放疗范围及剂量为鼻咽原发灶、阳性淋巴结的大体肿瘤体积处方剂量为T1、T2期69.96Gy,T3、T4期72~74Gy;亚临床高危区靶体积处方剂量为60~64Gy;淋巴结阴性引流区处方剂量为50~54Gy。分为单纯放疗组60例,同期化疗组60例。同期化疗方案为单药顺铂为基础的方案。主要观察两组的近期疗效、3年无瘤生存率（DFS）、3年无局部区域复发生存率（LRFS）、3年无远处转移生存率（MFS）、3年总生存率（OS）及治疗的毒副反应情况。结果：两组性别、年龄、病理类型及临床分期的构成比均有可比性。两组患者中位随访36个月。治疗结束3个月两组患者的完全缓解率分别为83.3%、80.0%,3年无瘤生存率分别为78.3%、75.0%,3年的无局部区域复发生存率分别为93.3%、90.0%,3年无远处转移生存分别为81.7%、83.3%,3年总生存率分别为88.3%、86.7%,两组统计学无明显差异。同期化疗组急性毒副反应高于单纯放疗组。结论：在调强放疗治疗模式下,局部晚期鼻咽癌同期化疗与单纯放疗相比,患者的3年总生存率及无瘤生存率未能进一步提高,而急性毒副反应增加,同期化疗在调强放疗模式下治疗策略需要行进一步的临床研究。Objective： To discuss intensity- modulated radiation therapy mode compare the efficacy of concurrent chemotherapy versus radiotherapy for locally advanced nasopharyngeal carcinoma after induction chemotherapy. Methods： Retrospectively analyze 120 patients with stage Ⅲ- Ⅳ locally advanced nasopharyngeal carcinoma. Using IMRT treatment,all patients had induction chemotherapy,radiation scope and dose for nasopharyngeal primary tumors,the gross tumor volume of positive lymph nodes prescribed dose was 69. 96Gy（ T1,T2） and 72 ~ 74Gy（ T3,T4）,clinical target prescribed dose of 60 ~ 64 Gy,lymph node negative prescribed dose of 50 - 54 Gy,divided into 2 groups,simple radiotherapy group 60 patients and concurrent chemotherapy group 60 patients. Concurrent chemotherapy regimens for single- agent platinum based solution. Recent curative effect,the 3- years of disease- free survival（ DFS）,locoregional recurrence- free survival（ LRFS）,distant metastasis- free survival（ MFS）,overall survival（ OS） and the side effects of treatment were observed. Results： Two groups of gender,age,pathological type and clinical stage of constituent ratio were comparable,2 groups of patients with a median follow- up time of 36 months. Treatment for over three months two groups of patients with complete response rate of 83. 3%,80. 0%,respectively,the 3- years of disease-free survival,78. 3%,75. 0%,LRFS 93. 3%,90. 0%,distant MFS 81. 7%,83. 3%,OS 88. 3%,86. 7%,respectively,no difference between the two groups statistically. IMRT concurrent chemotherapy group and acute toxicity reaction is higher than simple radiotherapy group. Conclusion： Intensity modulated radiation therapy（ IMRT） in the treatment mode,locally advanced nasopharyngeal carcinoma compared with concurrent chemotherapy and simple radiotherapy,does not improve the 3- years overall survival,disease- free survival,and acute side effects increase,concurrent chemotherapy on the condition of IMRT treatment strategies need to be further clinical research.

关 键 词：调强放疗 局部晚期鼻咽癌 同期放化疗 

分 类 号：R730.55[医药卫生—肿瘤]