甘氨双唑钠对局部复发性鼻咽癌再程放疗的增敏作用

Radiosensitization of Sodium Glycididazole in re-radiotherapy for local current nasopharyngeal carcinoma

目的研究甘氨双唑钠(CMNa)对局部复发鼻咽癌再程放疗的增敏作用以及不良反应。方法2006年4月至2007年6月,将60例病理确诊的鼻咽癌首程治疗完全缓解(CR)后局部(鼻咽)复发患者,随机分为试验组和对照组,每组30例。对照组:6MVX线体外放射治疗,放疗剂量:64～66GY/6.4～7.0周,每周照射5天,每天1次,10GY/周,设野根据患者临床和CT/MRI扫描所示病变范围,采用低熔点铅挡块不规则野,采用小野、多野等技术。试验组:将注射用甘氨双唑钠800mg/m2,用100ml生理盐水稀释溶解,30min内完成静脉滴注后于1～3小时内行常规放疗(方案同对照组),每周3次(周一、三、五),从放疗开始连续用药至放疗结束,约7周,共21次。观察疗效及不良反应。结果60例均可评价。鼻咽复发灶CR试验组和对照组分别为86.7%(26/30)、63.3%(19/30),P<0.05;1年生存率试验组和对照组分别为83.3%(25/30)、56.7%(17/30),P<0.05;1年无瘤生存率试验组和对照组分别为80.0%(24/30)、53.3%(16/30),P<0.05;两组患者的主要不良反应为粘膜、皮肤反应,但两组无显著差异(P>0.05)。结论甘氨双唑钠可以增加局部复发鼻咽癌的放疗敏感性,可以提高复发鼻咽癌近期疗效,无严重不良反应,能否提高长期生存率仍需进一步临床观察。

Objective To study the radiosensitive effects and toxicity of CMNa in re-radiotherapy for local recurrent nasopharyngeal carcinoma （NPC）. Methods From April 2006 to June 2007, sixty patients with local recurrent nasopharyngeal carcinoma confirmed by pathology were randomized into two groups：re-radiotherapy plus CMNa （test group） and re-radlotherapy alone（control group）.Re-radiotherapy was given by 200cGy perfraction,5 times per week to total dose of（64-66） Gy/6.4-7.0W , CMNa was given 800mg/m^2, 3 times a week（Monday ,Thursday ,Friday） until the re-radiotherapy was ended ,which was in solution of 100ml normal saline ,iv drip within 30 minutes. Radiotherapy was started in 1-3 hours after the completion of infusion. The effects and toxicity were evaluated after the therapy.Results All 60 cases had evaluable lesions. The CR rate of NP in test group and control group were 86.7%（26/30）, 63,3%（19/30）,respectively ,P〈0.05. 1-year survival rate were 83.3% （25/30）, 56.7% （17/30）,respectively ,P〈0.05; 1-year disease free survival rate were 80.0%（24/30）, 53.3%（16/30）,respectively,P〈0.05.The main toxicities were the reaction of skin and mocosa. But there was no statistical difference between the two groups.Conclusion CMNa can obviously increase the radiosensitiveness of local recurrent nasopharyngeal carcinoma cells. Combination of re-radiotherapy and CMNa can improve the short-term effective rate of local recurrent nasopharyngeal with no serious toxicity.Whether the long-term survival rate can be improved or not still need further observation .