头颈部鳞癌术后同步放化疗的临床疗效观察

Post-operative concurrent chemoradiotherapy for squamous cell carcinoma of the head and neck

目的探讨术后同步放化疗对局部晚期头颈部鳞癌的疗效。方法将术后局部晚期头颈部鳞癌患者146例随机分为观察(组(73例)和对照组(73例),均给予放疗,常规分割,总剂量50Gy。观察组在放疗同时给予DDP15mg/(m2.周)化疗。结果观察组和对照组2年的局部控制率分别为79%和64%(P=0.042),3年无瘤生存率分别为49%和33%(P=0.043),3年总生存率分别为61%和49%(P=0.134),3年局部复发率分别为21%和35%(P=0.042),3年远处转移率分别为23%和27%(P=0.568)。Ⅲ、Ⅳ级骨髓抑制发生率分别为38%和15%(P<0.001);Ⅲ、Ⅳ级放射性黏膜损伤发生率分别为55%和29%(P<0.001)。结论术后同步放化疗疗效优于术后单纯放疗,但未改善总生存率及远处转移率。

Objective To evaluate the clinical efficacy of concurrent chemo-mdiotherapy for local advanced squamous cell carci- noma of the head and neck. Methods After surgeries, 146 patients with advanced squamous cell carcinoma of the head and neck were randomly divided into two groups： the observation group with 73 patients and the control group with 73 patients. The obser- vation group received （2Gy per fraction, 5 fractions per week with a total dose of 50Gy） and concurrent chemotherapy（eisplatin 15 mg/m^2 per week）and the control group received only radiotherapy. Results In the observation and control groups, the two- year locoregional control rate was 79% and 64% respectively（P=0.042） ; the 3-year disease-free surviva/rate was 49% and 33 % respectively（ P = 0.043）; the 3-year overall survival rate was 61% and 49 % respectively （P=0.134）; the 3-year locore- gional recurrence rate was 21% and 35% respectively（ P = 0.042） ; the 3-year distant metastasis rate was 23% and 27% respec- tively（ P = 0.568） ; and the incidence rate of haemopoietic of grade 3 or greater was 38 % and 15 % respectively （ P 〈 0.001 ） ; the incidence rate of acute mucosa damage of grade 3 or greater was 55% and 29% respectively （ P 〈 0.001）. Conclusion Post-operative concurrent ehemo-mdiotherapy is more efficacious than post-operative concurrent radiotherapy only, but it has no ef- fect in improving the overall survival rate and distant metastasis rate.