中晚期鼻咽癌调强放疗联合同期化疗疗效分析

Effects of intensive-modulated radiotherapy with concurrent chemotherapy for advanced nasopharyngeal carcinoma

目的:探讨调强放疗联合同期化疗治疗中晚期鼻咽癌的疗效及不良反应。方法:60例中晚期鼻咽癌患者随机分为两组。A组(研究组):调强放疗联合同期化疗,B组(对照组):调强放疗。两组放疗方法相同:调强放疗加或不加下颈普放。原发灶及上颈采用调强放疗(IMRT),下颈采用IMRT或普放。采用逆向TPS。各靶区处方剂量均以其PTV定义。鼻咽肿瘤(GTVnx)和颈部转移淋巴结(GTVnd)处方剂量为69-72Gy。鼻咽预防区域PTV1处方剂量为60-65Gy。颈部预防区域PTV2处方剂量为50-60Gy。常规剂量体积保护关键器官。化疗采用DDP 60mg/m2d1iv dvip,5-FU750mg/m2d2-4iv dvip。与放疗同时开始,间隔3周,重复2-3个疗程。结果:A组鼻咽病灶CR率及有效率为81%(24/30)、96.67%(29/30),B组鼻咽病灶CR率及有效率为50%(15/30)、83.33%(25/30);A组颈部病灶CR率及有效率为73.33%(22/30)、90%(27/30),B组颈部病灶CR率及有效率为43.33%(13/30)、83.33%(25/30)。两组鼻咽病灶及颈部病灶CR率有显著性差异。但有效率及1、3年生存率无显著性差异。A组患者白细胞下降及恶心呕吐较B组严重,但患者可耐受。结论:中晚期鼻咽癌(NPC)联合同期化疗短期疗效CR率较单纯放疗好。但长期疗效未显示优越性,不良反应稍增加。

Objective： To study the effect of concurrent radio - chemotherapy and intensive - modulated radiotherapy （IMRT） only in the treatment of advanced nasopharyngeal carcinoma（NPC）. Methods： Sixty peitients with advanced nasopharyngeal carcinoma were randomly divided into 2 groups to receive concurrent radio - chemotherapy （group A , n = 30 ）and radiotherapy （group B, n = 30）respectively. The radiotherapy methods was the same in the two groups. The nasopharyngeal and neck lesions were irradiated with IMRT. The lower neck area was irradiated with conventional technique if the lesion was not on the border of upper and lower neck. The priscribed dose was 69 - 72Gy to GTVnx and GTVnd. 60 -65Gy to PTV1 encompassing preventive nasopharyngeal area, 60 -65Gy to PTV1 encompassing preventive neck area. Conventional dose was restrained to protect the key organs. DF chemotherapy was admini - stered in groupA（ DDP 60mg/m2 d1 iv dvip ,5 - FU 750mg/m2 d2 -4 iv drip）. The cycle was repeated for 2 -3 times.Chemotherapy and RT began at the same time. Results： Complete response rate （CR） and effective response rate （ER） of nasopharyrngeal lesion in group A were 81% （24/30） , 96.67 % （29/30） ; complete response rate and effective response rate of nasopharyrngeal lesion in group B were 50% （ 15/30）, 83.33 % （25/30） ;Complete response rate and effective response rate of neck lesion in group A were 73.33% （22/30） ,90% （27/30）, complete response rate and effective response rate of neck lesion in group B were 43.33% （13/30） ,83.33% （25/30）. There was a significant difference in CR rate between two groups. There was no significant difference in ER rate between two groups. 1, 3 year survival rates in group A were 90% （27/30） ,60% （18/30） , 1,3 year survival rates in group B were 83.33% （25/30） ,36.67% （11/30）. There was no significant difference in the survival curve between two groups. Conclusion： IMRT combined with concurrent chemotherapy was not better than IMRT in the treatment of advanced NPC.