后程加速超分割放疗联合同步化疗治疗鼻咽癌

Concurrent Chemotherapy in Combination with Late-Course Accelerated Hyperfractionation Radiotherapy for Nasopharyngeal Carcinoma

目的:后程加速超分割放疗联合同步化疗治疗中晚期鼻咽癌疗效的研究。方法:2003年5月-2005年5月,86例确诊为鼻咽癌患者分为常规组(全程常规分割放疗)和后加速组(化疗+后程加速超分割),每组43例。常规组照射2Gy/次,1次/天,每周5d,总剂量为70Gy。后加速组采用化疗方案为顺铂(DDP)(20mg/m2,第1～5天)+5-氟脲嘧啶(5-FU)(500mg/m2,第1～5天),每4周1疗程,共3疗程;于第1疗程结束时开始放疗,先常规分割:2Gy/d,每周5d,放疗剂量至36Gy后改为后程加速超分割照射:3Gy/d,总剂量66～69Gy。结果:放疗后1、3个月常规组和后加速组鼻咽部原发病灶和颈淋巴结完全缓解率、部分缓解率差异无统计学意义(P>0.05);第1、3年后加速组局部控制率高于常规组(P<0.05);后加速组无瘤生存率显著高于常规组(P<0.05),而生存率差异无统计学意义;后加速组急性黏膜反应明显重于常规组(P<0.01),但远期后遗症的发生两者差异无统计学意义;后加速组复发率显著低于常规组(P<0.05),平均复发时间也显著延长,但两组的转移率和平均转移时间差异无统计学意义。结论:后程加速超分割联合化疗的综合治疗能提高鼻咽癌局部控制率,降低其复发率。

Objective： To explore the value nf concurrent chemotherapy in combination with late- course hyperfractionation radiotherapy for treatment of advanced nasopharyngeal carcinoma. Methods： A total of 86 patients with advanced nasopharyngeal carcinoma were divided into two groups to receive conventional fractionation radiotherapy （CR group, n=43） or late-course accelerated hyperfractionation radiotherapy with concurrent chemotherapy （LCAF group, n=43）. Patients in CR group received a fraction of 2 Gy daily, 5 days per week, up to a total dose of 70Gy. Patients in LCAF group received chemotherapy containing DDP （20 mg/m2 , days 1 through 5） and 5-FU （500 mg/m2 , days 1 through 5） for three cycles, in addition to the conventional fractionation radiotherapy （2Gy daily, 5 days per week） until 36 Gy after the first cycle chemotherapy and then followed by LCAF （3 Gy daily） to complete a total dose of 66 - 69 Gy. Results： At 1 and 3 months after radiotherapy, there were no significant differences between CR group and LCAF group regarding the complete and partial remission rates of nasopharyngeal and cervical lymph node lesions （P〉 0.05）. At 1 and 3 years, the LCAF group showed better local control （P〈0.05） and higher rate of disease free survival （P〈 0.05） but not of overall survival as compared with the CR group. Acute mucositis was more obvious in the LCAF group （P〈0.01）, but there was no significant difference between groups regarding the long-term sequelae. Patients in the LCAF group experienced less recurrence and longer mean time to recurrence （P〈0.05）, however, the rate of metastasis and mean time to metastasis were similar between the both groups. Conclusion： concurrent chemotherapy in combination with late-course hyperfractionation radiotherapy can improve local control of nasopharyngeal carcinoma, and also can reduce the recurrence rate.