超分割放疗联合化疗治疗局部晚期鼻咽癌的疗效观察

The Observation of Combined Therapy with Hyperfractionation and Chemotherapy on Local Advanced Nasopharyngeal Carcinoma

目的:观察超分割放疗同时化疗对局部晚期鼻咽癌近期、远期疗效的影响及毒性反应。方法:69例Ⅲ、Ⅳa期初治NPC患者随机分为超分割放疗+化疗组;超分割放疗组;常规放疗组。鼻咽原发灶采用60Co外照射,颈部淋巴结引流区采用60Co前切线照射加深部X线垂直照射。结果:放疗结束后3个月时鼻咽原发灶消退率分别为80.0%、68.4%和55.0%,各组间无统计学差异(P>0.05);颈部淋巴结消退率分别为82.4%、52.9%和50.0%,其中化疗组明显高于常规放疗组(P<0.05),其余各组间均无统计学差异(P>0.05)。3年生存率(70.0%,73.7%,65.0%)。结论:超分割放疗同时联合化疗可提高近期颈部淋巴结的完全消退率,但未能提高长期生存率、改善局部控制率和减少远地转移率,其毒性反应可耐受。

Objective： To observe the short-term and long-term curative effect and adverse reaction of the combined therapy with hypeffractionation and chemotherapy on local advanced nasopharyngeal carcinoma （NPC）. Methods： A total of 69 patients with stage Ⅲ and Ⅳ a NPC receiving the initial treatment were randomized into the group of hypeffractionation plus chemotherapy, group of hypeffractionation and the group of conventional radiotherapy. The ^60Co external irradiation was employed for treatment of the NPC and the ^60Co anterior tangential irradiation plus vertical X-ray irradiation on deep part was used in drainage area of the lymph node of neck. Results： The regression rate of NPC focus 3 months after radiotherapy was 80.0%, 68.4% and 55.0%, respectively and there was no statistical difference between the group （P〉0.05）. The regression rate of the lymph node of neck was 82.4%, 52.9% and 50.0%, respectively, among which the regression rate in chemotherapy group was obviously higher than that in the conventional radiotherapy group （P〈0.05）. There was no significant difference between the groups （P〉0.05）. The 3-year survivals were 70.0%, 73.7% and 65.0%. Conclusion： The combined therapy with hypeffractionation and chemotherapy on local advanced NPC can improve the short-term complete regression of the lymph node of neck, but failed to enhance the long-term survival rate and local controls, as well as to reduce distant metastasis rate. The toxic reaction is tolerant.