局部进展期鼻咽癌同期调强放化疗Ⅰ期临床观察

Phase Ⅰ study of concurrent chemotherapy and intensity modulated radiotherapy （IMRT） in locally advanced nasopharyngeal carcinoma

目的前瞻性研究局部进展期鼻咽癌调强放疗联合同期化疗的不良反应，探讨同期调强放化疗的最佳剂量方法。方法2004年8月至2006年3月，20例Ⅲ-Ⅳa期的鼻咽癌患者在北京大学临床肿瘤学院接受了调强放疗和同期化疗。肿瘤靶体积和临床靶体积的放疗中位剂量分别是70、8和61、5Gy。同期化疗采用顺铂和氟尿嘧啶方案，化疗药物分为4个剂量水平。MRI和CT用于疗效评价。CTC2．0评分标准用于评价近期治疗相关的不良反应。结果中位随访时间是16、5个月。随访期间局部区域控制率是100％。2例出现远地转移。放疗结束时影像学评价疗效，完全缓解：20.0％，部分缓解：75．0％，稳定：5．0％。近期治疗相关不良反应随着化疗药物剂量的增加而加重。结论同期调强放化疗的近期不良反应程度与化疗药物剂量明显相关。选择同期化疗剂量时应将3、4度不良反应分别控制在30％～40％和10％以下。

Objective To determine the early toxicity of treatment in the patients with locally advanced nasopharyngeal carcinoma receiving IMRT with concurrent chemotherapy. Methods From Aug 2004 to March 2006, 20 patients were treated with IMRT and concurrent chemotherapy for nasopharyngeal carcinoma（stage Ⅲ-Ⅳa） in Peking University School of Oncology. The median total dose to the gross tumor volume and the clinical target volume was 70.8 and 61.5 Gy, respectively. The protocol of concomitant chemotherapy used in this study was 3 cycles of cisplatin plus fluorouracil. There were four dose-level groups in the study. Treatment related toxicities were scored according to the common toxicity criteria （NCI-CTC Version 2.0）. Results The median follow-up period for all patients was 16.5 months. No evidence of local recurrence for them was observed. Two patients had distant metastasis on the eighth month and the eighteenth month after beginning concurrent radiochemotherapy. Complete response and partial response were observed on MRI or CT scan at the end of treatment in 20 % and 75 % patients, respectively. One patient had no response. In the patients with concurrent chemotherapy, radiation induced side-effect of mucous membrane of mouth was significantly associated with dose level of chemotherapy. Conclusions Toxicities related to the treatment are significantly associated with the dose level of chemotherapy. Toxicities of the combination of IMRT and chemotherapy should be controlled by less than 30% to 40% for Grade 3, and 10% for Grade 4.