诱导化疗联合同期调强放化疗与单纯同期调强放化疗治疗局部中晚期鼻咽癌的疗效比较  

Efficacy Comparison of Induction Chemotherapy plus Concurrent Chemoradiotherapy and Concurrent Chemoradiotherapy Alone in the Local Advanced Nasopharyngeal Carcinoma

作　　者：冯成军 陈绍俊[1] 杨慧[1] 陈达桂[1] 陈海辉[1] 黄海欣[1] FENG Chengjun;CHEN Shaojun;YANG Hui;CHEN Dagui;CHEN Haihui;HUANG Haixin(Department of Oncology,the Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou 545005,China)

机构地区：[1]广西医科大学第四附属医院肿瘤科,广西柳州545005

出　　处：《肿瘤基础与临床》2018年第4期306-311,共6页journal of basic and clinical oncology

基　　金：柳州市科技攻关项目(编号:2013J030412)

摘　　要：目的比较诱导化疗联合同期调强放化疗与单纯同期调强放化疗治疗局部中晚期鼻咽癌的疗效。方法入组确诊的局部中晚期鼻咽癌患者278例,分别接受诱导化疗联合同期调强放化疗(133例)或单纯同期调强放化疗(145例)治疗。比较2组有效率、生存率、不良反应等。结果诱导化疗联合同期调强放化疗组与单纯同期调强放化疗组的5 a生存率、局部控制率、无远处转移生存率分别为82. 7%和82. 1%、84. 3%和81. 4%、78. 8%和73. 2%,比较差异均无统计学意义(P均> 0. 05)。亚组分析显示,局部T早期N晚期患者2组5 a生存率、无远处转移生存率分别为85. 5%和76. 9%、72. 7%和48. 6%,比较差异均有统计学意义(P均<0. 05);局部T早期N晚期患者2组5 a局部控制率比较差异无统计学意义(P <0. 05)。局部T晚期N早期患者2组5 a生存率、局部控制率、无远处转移生存率比较差异均无统计学意义(P>0. 05)。诱导化疗联合同期调强放化疗组的血液及消化系统不良反应较单纯同期调强放化疗组明显增加(P> 0. 05)。结论在调强放疗应用的过程中,诱导化疗应结合患者的临床病理特征,优化分层进行治疗,局部T早期N晚期患者可能有临床获益。Objective To compare the efficacy of induction chemotherapy plus concurrent chemoradiotherapy and concurrent chemoradiotherapy alone in the local advanced nasopharyngeal carcinoma. Methods The 278 patients with diagnosed local advanced nasopharyngeal carcinoma received induction chemotherapy followed by concurrent chemoradiotherapy （n = 133 ） or concurrent chemoradiotherapy alone （n = 145 ）. All the patients were treated with intensity-modulated radiotherapy. The response rates, survival rates and treatment-related adverse reactions were compared between the two groups. Results There was no significant difference between the induction chemotherapy followed by concurrent ehemoradiotherapy group and the concurrent ehemoradiotherapy group in the 5-year overall survival rate （82.7% vs 82.1% ） , the local control rate （84.3% vs 81.4% ） or the distance metastasis free survival rate （78.8% vs 73.2% ） （P 〉 0.05）. Subgroup analysis showed that compared with concurrent chemora-diotherapy, induction chemotherapy followed by concurrent ehemoradiotherapy significantly improved 5-year overall survival rate （85.5% vs 76.9% ） and the 5-year distance metastasis free survival rate （72.7% vs 48.6% ） in pa- tients with early T-stage and advanced N-stage disease （P 〈 0.05）. The hematologic and gastrointestinal adverse events during treatment in the induction chemotherapy followed by concurrent ehemoradiotherapy group were more than those in the concurrent chemoradiotherapy group. Conclusion Addition of induction chemotherapy to concurrent ehemoradiotherapy did not significantly improve the survival, however, the patients with early T-stage and advanced N-stage disease could benefit from induction chemotherapy.

关 键 词：鼻咽癌 诱导化疗 调强放疗 

分 类 号：R739.63[医药卫生—肿瘤] R730.58[医药卫生—临床医学]