交替化放疗治疗局部晚期鼻咽癌的疗效观察

Observation of the efficacy of alternating chemoradiotherapy for advanced nasopharyngeal carcinoma

目的:对比观察交替化放疗和单纯放疗治疗Ⅲ、ⅣA期鼻咽癌的疗效,探讨局部晚期鼻咽癌的治疗模式。方法:回顾性分析83例局部晚期鼻咽癌患者的临床资料,按照放疗是否联合化疗分为交替化放组(43例)和单纯放疗组(40例),交替化放组开始给予化疗,大野放疗,再化疗,然后缩小野放疗,化疗方案采用FP,单放组只行放射治疗,两组放射治疗技术基本一致。观察两组患者的治疗疗效和患者的耐受性。结果:交替化放组和单放组3年总生存率分别为74.4%(32/43)和52.5%(21/40),χ2=4.707,P=0.030;鼻咽原发灶肿瘤控制率分别为88.4%(38/43)和70.0%(28/40),χ2=4.295,P=0.038;颈部淋巴结转移灶肿瘤控制率分别为81.4%(35/43)和60.0%(24/40),χ2=5.144,P=0.023;远处转移率分别为14.0%(6/43)和35.0%(14/40),χ2=5.019,P=0.025。早期反应主要为白细胞下降和口腔黏膜炎,交替化放组较单放组明显,在支持治疗下患者均可耐受。结论:交替化放疗能降低局部晚期鼻咽癌远处转移率,提高肿瘤局部控制率和总生存率,患者可耐受性好,是一种值得尝试的新治疗模式。

OBJECTIVE：To compare the effects of alternating chemoradiotherapy and radiotherapy alone in the treatment of Ⅲ and Ⅳ A nasopharyngeal carcinoma （NPC）. METHODS： A total of 83 patients with advanced NPC diagnosed pathologically were divided into alternating chemoradiotherapy group（43） and radiotherapy alone group （40）. Alternating chemoradiotherapy （FP） was performed; initially,chemotherapy was administered, and then radiotherapy （wide field）, chemotherapy, radiotherapy （shrinking field）. The methods of radiation were the same in both groups. RESULTS：The overall 3 year survival rate were 74.4% （32/43） and 52.5%（21/40, X^2=4.702,P=0.030）. The control rates of the tumor of nasopharynx were 88.4% （38/43） and 20.0% （28/40, X^2 =4.295, P 0.038）, and the control rates of the tumor of neck were 81.4% （35/43） and 60.0% （24/40, X^2= 5. 144, P 0. 023）. The rate of distant metastasis were 14.0% （6/43） and 35.0%（14/40,X^2 =5. 019,P=0. 025）, respectively in alternating chemoradiotherapy group and radiotherapy alone group in turn. Early common toxicities include neutropenia and mucosities, and all patients could tolerate. CONCLUSIONS： The alternating ehemoradiotherapy in the treatment of local advanced NPC can decrease the rate of distant metastasis, and also improve local control rate and enhance the overall 3 year survival rate. The toxic reaction is tolerant. This method of alternating chemoradiotherapy is a new therapeutic modality, and is worth trying in clinical study.