同期放化疗治疗晚期口腔癌的临床观察

The clinical study of concurrent chemoradiotherapy in patients with local advanced oral cavity cancer

目的探讨以顺铂为基础方案同期放化疗治疗中晚期口腔癌的疗效及急性毒性反应。方法回顾分析42例Ⅲ、ⅣA期或手术后复发的口腔鳞癌患者资料,分为放化疗组和单放组。放化疗组22例患者行根治性外照射(4～8 MV X线,60～70Gy),并于第1、4、8周行以顺铂(80mg/m2)为基础的联合化疗;单放组20例行单纯放疗(剂量同放化疗组),观察比较两组近期疗效及急性毒性反应情况。结果放化疗组和单放组有效率分别为81.8%和60.0%,1年生存率分别为45.0%(9/20)和23.5%(4/17),2年生存率分别为25.0%(4/16)和7.7%(1/13),放化疗组的中位无局部进展生存期较单放组延长2个月。两组主要急性毒性反应为口腔黏膜炎、放射性皮炎、白细胞减少和恶心呕吐,放化疗组发生率均高于单放组,其中3～4级口腔黏膜炎两组差异显著(P<0.01)。结论同期放化疗治疗晚期或手术后复发口腔癌的近期疗效优于单纯放疗,但主要不良反应中3～4级口腔黏膜炎较明显,需积极的对症及支持治疗。

Objective To study the short-term efficacy and acute toxicity of concurrent chemoradiotherapy with cisplatin-based protocol for local advanced oral cavity carcinoma. MethodsForty-two patients with stage Ⅲ-ⅣA or of postoperation recurrence were enrolled in the retrospective study.Twenty-two patients were treated by concurrent radiotherapy（4-8 MV X-ray,60-70Gy） and chemotherapy with cisplatin and paclitaxel or cisplatin combing 5-fluorouracil at first,fourth and eighth week of the chemoradiotherapy（CRT group）.Twenty patients received radiation only（RT group） and dosage was same to CRT group. ResultsThe efficacy of CRT group was 81.8%,and RT group was 60.0%.The 1-year survival rate was 45.0% in CRT group,and 23.5% in RT group.The 2-year survival rates were 25.0% and 7.7%,respectively.The median regional progress-free time of CRT group was higher than RT group（8.5 months vs.6.5 months）.The major acute toxicity was mucositis,radiodermatitis,leukopenia,and nausea and vomiting,there was significant difference in grade 3-4 mucositis of two groups（P0.01）. ConclusionCisplatin-based protocol concurrent chemotherapy and radiotherapy may improve short-term efficacy for locally advanced or recurrent oral cavity cancer,but the grade 3-4 mucositis was obvious,and patients need receive symptom reducing and supporting therapy.