甘氨双唑钠对中晚期鼻咽癌放射增敏作用的临床研究

Clinical study on the radiosensitization of sodium glycididazole combined with radiotherapy for nasopharyngeal carcinoma

目的研究甘氨双唑钠(CMNa)对中晚期鼻咽癌的放射增敏作用以及不良反应。方法将48例确诊T2～3N2～3M0鼻咽癌患者随机分为研究组和单放组,每组24例。研究组CMNa800mg/m2,用09%生理盐水100ml稀释溶解后静脉输入,30min滴完,输入结束后60min内进行放射治疗,每周3次,从放疗开始连续用药至放疗结束,6～7周。单放组放疗方案同研究组。60Co体外常规放射治疗,鼻咽部DT(68～72)Gy·(34～36)次-1·(6～7)周-1,颈转移淋巴结DT(68～72)Gy·(34～36)次-1·(6～7)周-1,颈部预防量DT56Gy·28次-1·(5～6)周-1。结果鼻咽癌原发灶和颈淋巴结转移灶达完全缓解时放射增敏比(SER)分别为126和120(P<005)。研究组和单放组鼻咽癌原发灶CR分别为917%(22/24)、583%(14/24),P<001;颈淋巴结转移灶CR分别为875%(21/24)、542%(13/24),P<005。研究组和单放组鼻咽癌原发灶体积>50cm3时CR分别为875%(7/8)、333%(3/9),P<005;颈淋巴结转移灶体积>300cm3时CR分别为778%(7/9)、30%(3/10),P<005。两组未发现严重毒性反应。结论CMNa可以增加鼻咽癌原发灶及颈淋巴结转移灶的放射增敏比,对肿瘤体积较大者其放射增敏作用较明显;放疗合并使用CMNa可以提高中晚期鼻咽癌近期疗效,无严重不良反应。

Objective To study the radiosensitive effects and toxiciy of CMNa combined with radiotherapy for nasopharyngeal carcinoma(NPC).Methods Forty-eight patients with NPC were randomized into radiotherapy plus CMNa(group A) or radiotherapy alone(group B).Radiotherapy was given by conventional schedule:200cGy per fraction,5 times per week to total dose of (68～72)Gy/(6～7)W,CMNa was given 800mg/m2 3 times a week(Monday,Thursday,Friday) in solution of 100ml normal saline,iv drip within 30 minutes.Radiotherapy was started in 60 minutes after completion of infusion.Results The SER of NP lesion and neck lymph node were 1.26 and 1.20.The CR rate of NP and neck lymph node were 91.7%(22/24) and 87.5%(21/24) in group A,58.3%(14/24) and 54.2%(13/24) in group B respectively.The CR of NP lesion volume for <30cm3,30～50cm3,>50cm3 were 100%(7/7),88.9%(8/9),87.5%(7/8) in group A,83.3%(5/6),66.7%(6/9),33.3%(3/9) in group B.The CR of metastatic lymph node volume for <100cm3,100～300cm3,>300cm3 were 100%(6/6),88.9%(8/9),77.8%(7/9) in group A,85.7%(6/7),57.1%(4/7),30%(3/10) in group B respectively.There was no serious toxicity in two groups.Conclusions CMNa can obviously increase the radiosensitiveness of both primary and metastatic NPC especially those large volume of NPC.Combination of radiotherapy and CMNa can improve the CR of medial-later phage NPC with no serions toxicity.