后程适形放疗联合化疗治疗Ⅲ、Ⅳa期鼻咽癌的临床研究

Late course conformal radiotherapy combined with chemotherapy for stage Ⅲ and Ⅳa nasopharyngeal carcinoma

目的评价后程适形放疗(3DCRT)联合化疗治疗局部晚期鼻咽癌的临床疗效及毒副作用。方法将96例Ⅲ、Ⅳa期鼻咽癌(NPC)随机分为后程适形放疗联合化疗组(实验组)46例及常规放疗联合化疗组(对照组)50例。两组放疗前予顺铂(DDP)+亚叶酸钙(CF)+5氟脲嘧啶(5FU)方案(CPF方案)化疗1周期,放疗结束再化疗1周期。实验组化疗后先常规放疗至鼻咽DT36～40Gy,后改3DCRT加量鼻咽总量DT70～86Gy。对照组化疗方案同实验组,放疗采用常规放疗,总量DT68～86Gy。结果两组鼻咽肿瘤全消率和1年生存率比较差异无统计学意义;实验组鼻咽癌1年局部控制率明显高于对照组(分别为97.83%,78.00%,P=0.003);两组远处转移率比较差异无统计学意义;实验组放射性龋齿、放射性中耳炎发生率明显低于对照组(P=0.004,0.000);两组恶心呕吐、血液毒性、Ⅲ～Ⅳ度口腔黏膜反应无明显差异。结论后程3DCRT联合化疗可以提高局部晚期鼻咽癌的局部控制率和减少远处转移,减少放射性损伤和放射并发症。

Objective To evaluate the effect and acute toxicity of late course conformal radiotherapy combined with chemotherapy for stage Ⅲ and Ⅳa nasopharyngeal carcinoma (NPC). Methods Ninety-six patients with stage Ⅲ and Ⅳa NPC were randomly divided into 2 groups: test group (n=46, undergoing late course conformal radiotherapy combined with chemotherapy) and control group (n=50, undergoing conventional radiotherapy). Both groups were treated with one-period chemotherapy, including cisplantin, 5-fluouracil, and calcium folinate, before and after the radiotherapy. The radiotherapy of the test group consisted of 2 phases: 36.0~40.0 Gy in 18~20 fractions over 3.5~4 weeks as the first phase using conventional technique was delivered with 2 lateral opposing faciocervical fields, and then 30.0~46.0 Gy in 15~23 fractions over 3~4.5 weeks as the second phase using three-dimensional conformal radiotherapy (3D-CRT). Results The rates of complete remission (CR), partial remission (PR), and no change (NC) of the test group were 95.65%, 4.35%, and 0, not significantly different from those in the control group (90.00%, 10.00%, and 0, P=0.287). The 1-year survival rate of the test group was 100%, not significantly different from that of the control group (96.00%, P=0.170). The nasopharyngeal 1 year control rate of the test group was 97.83%, significantly higher than that of the control group (78.00%, P=0.03). The distant metastasis rate of the test group was 8.70%, not significantly different from that of the control group (12.00%, P=0.596). The incidence rates of radiological caries and irradiation-induced otitis media in the test group was 4.25% and 17.39% respectively, both significantly lower than those in the control group (26.00% and 42.00% respectively, P=0.004 and P=0.000). There was no significant difference in the incidence of nausea, vomiting, leukopenia, and severity of acute mucositis between these 2 groups. Conclusion Late course conformal radiotherapy combined with chemotherapy effectively improves the disease control, delays the distant metastasis, and alleviates radioactivity damnification.