不同方案化疗结合调强放疗治疗局部晚期鼻咽癌临床病理回顾性分析

Restrospective analysis of effectiveness of different chemotherapy regimens combined with intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma

目的:探讨不同化疗方案结合调强放射治疗局部区域晚期鼻咽癌的相关毒副反应及疗效。方法:回顾性分析213例局部晚期鼻咽癌患者,按与调强放疗结合的不同方式分为单纯放疗组61例、DDP同期放化疗组54例、DDP+5-FU(PF)方案诱导化疗联合DDP同期放化疗组66例、紫杉醇+Carboplatin(TC)方案诱导化疗联合DDP同期放化疗组32例。调强放射治疗采用同期整合加量技术治疗。比较各组患者的肿瘤控制情况和治疗毒副反应。结果:各组患者5年总生存率分别为82.4%、78.9%、84.0%、77.2%(P=0.950),无瘤生存率75.0%、74.6%、82.3%、74.0%(P=0.891),无局部复发率90.2%、96.2%、98.4%、90.4%(P=0.226),无远处转移率83.2%、77.8%、83.9%、83.7%(P=0.798)。治疗相关毒副反应主要为骨髓抑制、胃肠道反应和放射性黏膜炎,前两者化疗组与单纯放疗组差异有统计学意义。影响预后的多因素分析结果显示,总生存率仅与N分期相关。结论:与单纯调强放射治疗相比,PF和TC诱导化疗、DDP单药同期化疗或者两者序贯联合均未能提高肿瘤局部区域控制率和生存率,胃肠道和骨髓毒副反应有所增加。

OBJECTIVE：To analyze the effectiveness and toxicity of different chemotherapy regimens combined with intensity-modulated radiotherapy （IMRT） treating locoregionally advanced nasopharyngeal carcinoma.METHODS：A total of 213 patients with locoregionally advanced nasopharyngeal carcinoma were restrospectively reviewed and classfied into four groups：61 patients were treated by radiotherapy alone,54 patients by concurrent chemoradiotherapy （CRT）,66 patients by DDP＋5-FU combined with CRT and 32 patients by Taxol ＋ Carboplatin combined with CRT.Simoustaneously integrate boost technique by IMRT was used.The tumor control,survival and treatment toxicity were analyzed.RESULTS：For the RT,CRT,PF＋CRT and TC＋CRT group,the 5-year overall survival was respectively 82.4%,78.9%,84.0%and 77.2%（P=0.950）,disease-free survival 75.0%,74.6%,82.3% and 74.0%（P=0.891）,distant metastasis-free survival 90.2%,96.2%,98.4% and 90.4%（P=0.226）and local-regional failure-free 83.2%,77.8%,83.9% and 83.7%（P=0.798）.The treatment-related toxicities were mainly myelosuppression,gastrointestinal,mucositis,and previous two occurred more frequently in patients treated by chemotherapy than by not.Cox regression analysis showed that only N stage was a prognostic factor.CONCLUSION：Comparing with IMRT alone,the addition of PF,TC regimens induction chemotherapy,DDP single agent concurrent chemotherapy or their sequently combination do not increase the tumor control and survival.