手术在早期鼻咽癌综合治疗中的作用研究

The Study on the Role of Operation for Synthetical Therapy of the Early Nasopharyngeal Carcinoma

目的:探讨手术在早期鼻咽癌综合治疗中的作用及可行性。方法:按第5届鼻咽癌协作组会议(长沙,1979年)TNM分期方案,对82例早期鼻咽癌(T1～2、N0～1、M0)患者随机分为2组。即手术组42例、对照组40例。手术组采用手术+放射治疗的综合疗法,其中鼻咽部肿瘤量为60～70Gy,同时于术中、术后10天各给环磷酰胺1g进行化疗;对照组采用单纯放射治疗,鼻咽部肿瘤量为72～78Gy。两组病人均采用钴机和深部X光机进行放疗。观察两组鼻咽部放射剂量及5年、10年的生存率。结果:手术组的鼻咽部放射剂量为64.28±5.46Gy,对照组为74.02±3.22Gy;5年生存率,手术组为85.71%(36/42),对照组为75.00%(30/40),两者比较无统计学意义(P>0.05);10年生存率,手术组为73.81%(31/42),对照组为52.50%(21/40),两者比较差异有显著性(P<0.05)。结论:早期NPC的手术治疗是可行的,其既可间接地提高放射治疗的敏感性,减小放疗量,又与放疗有良好的协同作用,提高早期NPC治疗的远期疗效。

Objective: To study the role and the feasibility of the operation for synthetical therapy of the early nasopharyngeal carcinoma. Methods: According to the classification of the UICC(1987), 82 cases of early nasophyngeal carcinoma were divied randomly into the operation group and control group. The operation group (42 cases) was given surgical operation in combination with radiotherapy and chemotherapy, while radiotherapy dosage was 60~70GY in nasopharynx. Intraoperative chemocherapy and postoperative chemotherapy (10 days after operation) with 1 gram Cytoxan were supplied. The control group (40 cases) was only given radiotherapy and with dosage 72~78GY in nasophyngnx. The two groups received Cobalt-60 and deep X-ray radiotherapy and they were followed-up for 10 years. Results: The radiotherapy dosage in nasopharynx for the operation group was 64.28±5.46GY and the radiotherapy dosage for the control group was 74.02±3.22GY; the 5-year survival rates were 85.71% (36/42) in the operation group and 75% (30/40) in the control group. The statistical comparison showed no significant difference between the operation group and control group (P>0.05). The 10-year survival rate was 73.81% (31/42) in the operation group and 52.50% (21/40 ) in the control group, respectively. The survival rate of the operation group increased remarkably (P<0.05). Conclusion: The surgical operation in primary nasopharyneal carcinoma is feasible, which can indirectly raise the sensitivity of the radiotherapy, reduce the radiopherapy dosage and may raise the late result on early nasophyngeal carcinoma.