鼻咽癌三维适形放射治疗的临床研究

Clinical study on three dimensional conformal radiationtherapy for nasopharyngeal carcinoma

目的探讨鼻咽癌三维适形放射治疗的疗效及毒副作用。方法112例初治鼻咽癌患者随机分为两组：A组（n=56）为三维适形放射治疗组（3DCRT），13组（n=56）为常规放射治疗组（CFRT），两组均辅以相同的化学治疗：DDP（60mg／m2，d1）＋5-FU（500mg／m2，d1～5），每4周为1程，共3个疗程。放疗于第一程化疗结束后立即执行。放疗总剂量（DT）：A组为72～76Gy，7．2～7．6周；B组为66～72Gy，6．6～7。2周。观察对比两组患者治疗后原发灶消退情况、颈淋巴结消退情况和放疗毒副反应。结果112例病人均完成治疗。放疗结束后3个月，原发灶消退情况：A组完全缓解率（CR）为96．4％（54／56），B组CR为82．1％（46／56）：颈淋巴结消退情况，A组CR为100％（56／56），B组CR为96．4％（54／56）。放疗毒副反应：口腔粘膜反应A组比B组程度轻，骨髓抑制、皮肤反应及胃肠道反应等，两组比较程度相当。结论鼻咽癌三维适形放射治疗，跟常规治疗比较，在可以不增加放疗毒副作用的前提下提高放疗剂量，从而提高了局部控制率。

Objective To evaluate the clinical efficiency and toxicity of three dimensional conformal radiationtherapy （3DCRT） for nasopharyngeal carcinoma （NPC）. Methods 112 NPC patients were randomized into two groups, A group（n=56） is treated with three dimensional conformal radiationtherapy （3DCRT）; B group（n=56） is treated with conventional fractionation radiationtherapy （CFRT）. All of 112 patients plus concurrent chemotherapy ： Cisplatin （DDP, 6Omg/m2 dayl） and 5-fluorouracil （5-Fu, 500mg/m2 days 1~5）, once 4 weeks for three cycles. At the end of first cycle Chemotherapy, followed by radiation therapy. The total dose （DT）： A group：72~76Gy, 7.2~7.6weeks;B group：66~72Gy, 6.6~7.2weeks. Results All patients had finished the course of treatment. The complete response（CR） rate of the primary lesion and cervical node in A, B groups were 96.4% vs 82.1% （P〈0.05）and 100% vs 96.4% （P〉0.05） after three months of treatment. The toxicity A group is low-grader than B group in mouth（P 〈0.05）. The toxicity of skins, leukopenia and vomiting is non-significant in A group and B group. Conclusion 3DCRT can improve the elimination rate for nasopharyngeal carcinoma than CFRT by boost the total dose, without increase the toxicity.