化疗配合加速分割放疗治疗Ⅲ和Ⅳ A期鼻咽癌的临床观察

Chemotherapy combined with accelerated fractionated radiotherapy on stage Ⅲ and ⅣA nasopharyngeal carcinoma

目的:对比观察诱导化疗和后程同步化疗配合加速分割放疗治疗Ⅲ和ⅣA期鼻咽癌的疗效。方法:72例Ⅲ和ⅣA期鼻咽癌患者分成诱导化疗配合加速分割放疗组(36例,A组)和后程同步化疗配合加速分割放疗组(36例,B组)两组;均采用每周照射6d,每天1次,每次1.8～1.9Gy的加速分割放疗方法,A组在放疗前用PF方案化疗,B组放疗至36～38Gy缩野后加用PF方案同步化疗。结果:A组和B组鼻咽肿块控制率分别为91.7%(33/36)和94.4%(34/36),P=0.64;颈部肿块控制率分别为81.3%(26/32)和77.4%(24/31),P=0.71;颈淋巴结完全消退时剂量分别为(44.78±11.79)和(50.03±13.03)Gy,P=0.14。A组和B组鼻咽肿块CR率分别为80.6%(29/36)和83.3%(30/36),P=0.76;1年远处转移发生率分别为16.7%(6/36)和13.9%(5/36),P=0.74,1年生存率分别为94.4%(34/36)和91.7%(33/36),P=0.64。结论:诱导和后程同步化疗配合加速分割放疗对Ⅲ和ⅣA期鼻咽癌均获得较好的局部控制率,但两者的疗效无差异,急性毒副反应相当,能耐受,其长期疗效及后期不良反应有待进一步随访观察。

OBJECTⅣE： To compare neoadjvant chemotherapy combined with accelerated fractionated radiotherapy （AFR）and late course concurrent chemotherapy with AFR on stage In and Ⅳ A Nasopharyngeal Carcinoma （NPC）. METHODS： 72 patients with stage Ⅲ and Ⅳ A NPC were randomized into two groups： neoadjvant chemotherapy combined with AFR group （group A） 36 patients, late course concurrent chemotherapy with AFR group （group B） 36 patients. Two groups also received 6 fraction per week, one time per day, 1.8- 1.9 Gy per fraction to a total dose of 72-79.8 Gy. What to different is that group A was treated by PF schemes before irradiation ,and group B was treated by concurrent chemotherapy followed by AFR to a dose 36-38 Gy. RESULTS： When radiotherapy was completed, the control rates of the tumor of nasopharynx of group A and B were 91.7%（33/36） and 94.4%（34/36） （P： 0.64）, the tumor of neck were 81.3% （26/32） and 77.4%（24/31） （P：0.71） respectively. The dose of complete remission of group A and B were 44.78± 11.79, 50. 03± 13.03 Gy （P：0.14）, the complete remission CR of nasopharyngeal tumor were 80.6%（29/36） and 83.3%（30/36） （P：0.76）, and the 1-year survival rate were 94.4%（34/36）, 91.7%（33/36） （P： 0.64） respectively. CONCLUSIONS： This study shows that neoadjvant chemotherapy and late course concurrent chemotherapy combined with AFR can also improve local control rate on stage Ⅲ and Ⅳ A NPC, but there is no difference in latest curative effect. The long- term survival rate and the late complication need follow up.