螺旋断层根治性放疗联合同步化疗治疗局部晚期下咽癌疗效分析

Therapeutic effect of radical helical tomotherapy combined with concurrent chemotherapy on locally advanced hypopharynx cancer

目的:评价螺旋断层根治性放疗联合同步化疗和/或抗EGFR单克隆抗体治疗局部晚期下咽癌的疗效及不良反应。方法:回顾性分析螺旋断层根治性放疗联合同步化疗和/或抗EGFR单克隆抗体治疗局部晚期下咽癌患者30例。下咽原发病灶及转移淋巴结根治性放疗计划剂量均为70 Gy/33 F、PTV1 60 Gy/33 F、PTV2 54 Gy/33 F。结果:47%患者发生了3～4级急性反应,未发生≥3级的晚期反应。30例患者放疗过程中除2例死于原发部位大出血,其余28例患者中位随访时间为15.5(3～41)个月,1和2年的原发病灶控制率、淋巴结控制率、远处转移控制率和生存率分别为63%和35%、84%和61%、89%和81%、8%和50%。全组患者治疗失败11例,原发病灶进展为最常见的失败原因。结论:螺旋断层放疗联合同步化疗和/或抗EGFR单克隆抗体治疗局部晚期下咽癌患者能很好地耐受,临床疗效较好。

Objective： This study aimed to evaluate the toxicity and therapeutic effect of radical helical tomotherapy （RHT） combined with concurrent chemotherapy in treating locally advanced hypopharyngeal cancer （HPC）. Methods： Thirty patients with locally advanced HPC were treated by RHT combined with concurrent chemotherapy. The RHT dosage was as follows： 70 Gy/33 F was used in the pGTVnx＋ pGTVnd treatment, 60 Gy/33 F in PTV1, and 54 Gy/33 F in PTV2. Early and late radiation side effects were evaluated against the rating scales of the Radiation Therapy Oncology Group of the European Organization for Research and Treatment. Results： Early side effects （i. e., grades 3 and 4 acute reactions） occurred in 47% of the 30 patients. Late side effects （i.e., grade 3 and higher） were not observed. Among the 30 patients, 2 died during radiotherapy for locoregional hemorrhea. In the other 28 patients, the median of follow-up time was 15.5 months （range = 3 - 41 months）; the one- and two-year local relapse-free, lymph node metastasis-free, distant metastasis-free, and overall survival rates were 63% and 35%, 84% and 61%, 89% and 81%, as well as 58% and 50%, respectively. Treatment failed in 11 cases mainly because of progression of the primary lesion. Conclusion： RHT combined with concurrent chemotherapy for locally advanced hypopharyngeal cancer is well tolerated and rproduces satisfactory clinical outcomes.