恩度联合放化疗治疗鼻咽癌的临床疗效观察

目的探讨恩度(重组人血管内皮抑制素)联合放化疗治疗鼻咽癌的有效性和安全性。方法经病理组织学确诊为中晚期鼻咽癌患者60例(Ⅲ期和Ⅳa期),按肿瘤分期进行配对处理后分为:试验组:同步放化疗+恩度治疗30例,对照组:同步放化疗30例。放疗:采用加速器6MV X线常规分割放疗,每周5次,每次2Gy,先面颈联合野加中下颈切线野放疗至36~38Gy,随后改为耳前野加全颈切线野或小面颈联合野加下颈切线野,鼻咽部总剂量为70~78Gy/7~8周,颈部根治量为60~68Gy,预防量为50~56Gy。化疗:在放疗第1周及第4周配合化疗,化疗方案为卡铂50mg/m2,d1-5,氟脲嘧啶500mg/m2,d1-5。化疗期间常规给予止吐、水化、利尿等。其中恩度15mg加入生理盐水500ml中静脉滴注,第1~14天连续给药,14天为一个疗程,住院期间给予两个疗程。按照RECIST标准评价近期疗效,按照NCICTC3.0版标准评价毒性反应。放化疗结束后3个月依据影像学检查评价疗效。结果本组60例均可评价客观疗效,其中治疗组CR 12例,PR16例,SD 1例,PD1例,即客观有效率(RR)为93.3%(28/30),疾病控制率(DCR)为96.7%(29/30);对照组CR 11例,PR15例,SD2例,PD2例,即客观有效率(RR)为86.7%(26/30),疾病控制率(DCR)为93.3%(28/30)。其中治疗组的2年局部无复发生存率、无远处转移生存率、总生存率分别为100%、96.7%、100%,对照组2年局部无复发生存率、无远处转移生存率、总生存率分别为100%、93.3%、100%。两组毒副反应比较无明显差异。结论恩度联合同步放化疗治疗鼻咽癌具有良好的局部控制率,毒性较低,安全性及耐受性比较好,可能对减少鼻咽癌远处转移,延长患者生存时间有一定的作用。

Objective To discuss efficacy and safety of Endostar (Recombinant Human-- Endostatin Injection ) ;combined with the radio-therapy and chemotherapy in the treatment of nasopharyngeal carcinoma .Methods According to the tumor stage ,60 patients with advanced naso-pharyngeal carcinoma (stage Ⅲ and stage Ⅳa) confirmed by histopathology ,were divided into the two groups ,the experimental group has imple-mented in the concurrent chemoradiotherapy combined with Endostar ,the control group carries on the concurrent chemoradiotherapy .Radiation the accelerator 6 MV X-ray conventional radiotherapy ,5 times a week ,each time 2Gy ,first facial-cervical field and the lower neck tangential radio-therapy to 36 ~ 38 Gy ,then the preauricular boost whole neck tangential or facet joint under the neck neck boost tangent field ,total dose naso-pharynx was 70 ~ 78 Gy /7 to 8 weeks ,radical neck is 60 ~ 68Gy ,prevent quantity is 50 ~ 56 Gy .Chemotherapy at first weeks and 4 weeks of radiotherapy combined with chemotherapy ,chemotherapy of carboplatin 50 mg/m2 D1-5 ,5-FU ,500 mg/m2 ,d1-5. During chemotherapy given conventional antiemetic ,hydration ,diuresis .The Endostar 15 mg added 500 ml saline intravenously ,first ~ 14 days continuous administration , 14 days for a course of treatment ,the hospital to give two courses .Efficacy was evaluated according to RECIST standard ,evaluation of toxicity in accordance with the NCICTC3.0 standard .Chemotherapy after the end of March based on the imaging effect evaluation .Results The group of 60 patients could be evaluated objectively the curative effect ,12 cases ,group CR for which PR16 cases ,SD 1 cases ,PD1 cases ,namely the Objective response rate (RR) was 93.3% (28 /30) ,disease control rate (DCR) was 96.7% (29 /30);the control group CR 11 cases ,PR15 cases ,SD2 ca-ses ,PD2 cases ,namely Objective effective rate (RR) was 86.7% (26 /30) ,disease control rate (DCR) was 93.3% (28 /30) .The treatment group 2 years local recurrence-free survival ,distant metastasis-free survival ,overall survival rates were 100% ,96.7% ,100% ,2 years of local re-currence-free survival ,distant metastasis-free survival ,overall survival rates were 100% ,93.3% ,100% in the control group .No significant difference was found between the adverse reaction of two groups .Conclusion Endostar combined with concurrent radiotherapy and chemotherapy in the treatment of nasopharyngeal carcinoma with good local control rate ,low toxicity ,safety and tolerability of relatively good ,may be to reduce distant metastasis of nasopharyngeal carcinoma ,have certain effect to prolong the survival time of patients .