鼻咽癌时间调节化疗诱导加同期调强放疗的疗效分析

Analysis of treatment effect of chronomodulated chemotherapy plus concurrent intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma （ NPC ）

目的探讨顺铂＋氟尿嘧啶（PF）方案时间调节化疗诱导加同期调强放疗（IMRT）治疗鼻咽癌的临床疗效。方法回顾性分析48例初治鼻咽癌患者行PF方案时间调节化疗诱导联合同期放化疗的疗效。将鼻咽和颈部的靶体积划分为鼻咽大体肿瘤体积（GTVnx）、颈部大体肿瘤体积（GTVnd）、临床靶体积1（CTV1）和临床靶体积2（CTV2）。GTVax、GTVnd、CTV1、CTV2处方剂量分别73．92～77．88、69．96、60．06—66．00、50．96—56．00Gy，采用传统照射分割方式。采用Kaplan—Meier法进行生存分析。RTOG／EORTC标准评价急性反应和晚期损伤。结果完全缓解（CR）20例，占41．6％，部分缓解（PR）23例，占47．9％，稳定（SD）2例，占4．2％。肿瘤局部控制率为89．6％，1、2、4年的生存率分别是93．8％、79．2％、64．5％。多数患者仅表现为1～2级急性反应和0—1级晚期损伤，未观察到4级急性反应和晚期损伤。剂量体积分布直方图（DVH）分析显示IMRT提高了靶体积照射总剂量和分次剂量，减少了危及器官受照总剂量和分次剂量。结论PF方案时间调节化疗诱导加同期配合IMRT是鼻咽癌安全的治疗方案。

Objective To evaluate the therapeutic effects, acute and late side-effects of cisplatin plus 5-fluorouracil （PF） schemed chronomodulated chemotherapy combined with concurrent intensity- modulated radiotherapy（IMRT） for nasopharyngeal carcinoma. Methods A total of 48 nasopharyngeal carcinoma patients treated with chronomodulated chemotherapy plus concurrent IMRT were retrospectively studied. The radiation doses prescribed to the gross target volume GTV of nasopharyngeal, to the positive neck lymphnodes GTVnd, to the clinical target volume CTV1, and to CTV2 were 73.92 - 77.88, 69.96, 60. 06- 66. O0 and 50.96 -56. 00 Gy respectively. The Kaplan-Meier survival analysis was used to calculate the local-regional progression-free rate. The acute and late side-effects were graded according to RTOG radiation morbidity scoring criteria. Results The complete remission （CR） rate was 41.6% （20/48） ; the partial remission （PR） rate was 47.9% （23/48） ; the stable disease （SD） rate was 4. 2% （2/48） ; and the local tumor control rate was 89.6%. Most of the patients had grade 1 to 2 acute side effects and grade 0 to 1 late side-effects. No grade 4 acute and late toxicity was observed. 1, 2, 4-year survival rates were 93.8%, 79.2% and 64. 5%, respectively. The DVH analysis showed that IMRT improved the total dose and dose per-fraction to the target volume with considerable dose reduction of the normal structures at the same time. Conclusions PF chronomodulated chemotherapy plus concurrent intensity-modulated radiotherapy for NPC could improve therapeutic effects with satisfactory tolerance of the side effects.