鼻咽癌颈部淋巴结转移综合治疗的远期疗效观察

Long-term clinical outcome of combined therapy for nasopharyngeal carcinoma with cervical lymph node metastasis

目的 观察鼻咽癌放化疗配合颈部淋巴结微波热疗的远期疗效.方法 154例初治N2～N3期鼻咽癌患者随机分为对照组（78例）和热疗组（76例）.对照组用氟尿嘧啶＋顺铂化疗1～2周期（21 d为1周期）后原发灶常规放疗DT 70～78 Gy分35～39次,颈淋巴结转移灶DT 68～72 Gy分34～36次.热疗组放化疗方法同对照组,颈淋巴结于放疗第1周开始配合局部热疗,每次加温45min,2次/周,共8～14次.结果 热疗组、对照组5年颈淋巴结局部控制率分别为97%和77%（X2=14.24,P〈0.01）,远处转移率分别为37%、44%（X2=0.73,P〉0.05）,无瘤生存率分别为51%、21%（X2=15.91,P〈0.01）,总生存率分别为59%、41%（X2=5.09,P〈0.05）.结论 对N2、N3期鼻咽癌放化疗配合颈淋巴结微波热疗的5年颈淋巴结局部控制率、无瘤生存率和总生存率均优于单纯放化疗组.

Objective To evaluate long-term efficacy of microwave hyperthermia combined with chemoradiotherapy for nasopharyngeal carcinoma （NPC） with cervical lymph node metastasis. Methods A total of 154 patients with stage N2 or N3 NPC （＇92 staging system） were randomized into two groups：microwave hyperthermia combined with chemoradiotherapy （Group A, 76 cases） and chemoradiotherapy alone （Group B, 78 cases）. Both of the two groups received 1 -2 cycles of chemotherapy of cisplatin and 5-fluorouracil, followed by conventional radiotherapy of 70 - 78 Gy in 35 - 39 fraction to the nasopharynx and 68 -72 Gy in 34 - 36 fractions to the neck. Group A received microwave hyperthermia to the metastatic cervical nodes at the beginning of radiotherapy. The hyperthermia was given as 45 min every time, twice a week for 8 - 14 times totally. Results The 5-year complete response rates of cervical lymph nodes in group A and B were 97% and 77% （x2 = 14. 24,P〈0. 01）. The distant metastasis rates in the two groups were 37% and 44% （x2 = 0. 73, P 〉 0. 05）. The disease-free survival rates were 51% and 21% （x2 = 15.91, P 〈0. 01）. The 5-year overall survival rates were 59% and 41%, respectively （x2 = 5.09, P 〈 0. 05）.Conclusions For patients with stage N2 or N3 NPC, microwave hyperthermia combined with chemoradiotherapy can improve the complete response, disease-free survival and overall survival.