局部晚期鼻咽癌治疗新进展

Progress in the treatment of loco-regionally advanced nasopharyngeal carcinoma

目前局部晚期鼻咽癌的治疗热点主要有4个方面：非常规分割照射；三维适形放疗（3-DCRT）与调强放疗（IMRT）；放化疗综合治疗；放疗与靶向药物综合治疗。IMRT是精确放疗发展的主要方向，其有更好的适形度和靶区剂量分布，可将局控率提高至90％以上，且能较好地保护肿瘤周围的正常组织。但远处转移率仍为20％-25％，限制着总生存率（overall survival，OS）的提高。为进一步巩固IMRT对肿瘤的局控率和降低远处转移率，采取放化综合治疗仍为必需。从目前发表的临床随机研究以及Meta分析的结果可知，化疗能在放疗的基础上将局部晚期鼻咽癌的OS提高6％以上，其中同期放化疗疗效最为显著。

At prasent there are four aspects that have been deeply studied in the treatment of loco-regionally advanced nasopharyngeal carcinoma. They are non-conventional fractionated radiotherapy, 3-DCRT and IMRT, chemo-radiotherapy, and radiotherapy combined with targeted drugs. IMRT is the major direction of advancement for precise radiotherapy, with more conformity and precise dose distribution. It brings local control rates up to 〉 90% with better sparing of the surrounded normal tissue. However, the metastasis rate is still 20% -25%, which limits the improvement of overall survival （ OS）. To consolidate the local control rate and reduce the metastasis rate, it is necessary to combine chemotherapy with radiotherapy. According to clinical randomized studies and meta-analysis, chemotherapy can improve the OS of loco-regionally advanced nasopharyngeal carcinoma by more than 6% with radiotherapy alone as baseline. Concurrent chemo-radiothera- py is the most promising strategy to cope with the disease. This review has summarized the progress in the area of combination of chemotherapy and radiotherapy for the treatment of loco-regionally advanced nasopharyngeal carcinoma.