单纯根治性放疗与放疗联合化疗治疗鼻咽癌的远期疗效分析

Effect of radiotherapy alone or radiotherapy combined with chemotherapy on nasopharyngeal carcinoma:Analysis of long term results

目的 回顾性分析比较单纯根治性放射治疗与放射治疗联合化疗治疗鼻咽癌的远期疗效并分析其它相关因素对其预后的影响。方法 从 1988年 1月至 1996年 3月共住院收治 895例鼻咽癌。根据不同的治疗方法分为两组 ,单纯根治性放射治疗组 (单放组 ) 768例 ,放疗方式包括常规、腔内及超分割放疗 ,采用常规设野 ,照射剂量为 68～ 79.6Gy ;根治性放射治疗同期联合化疗组 (联合组 ) 12 7例 ,放疗方法同单放组 ,同期化疗 2～ 3个周期 (方案为DDP +5 Fu或DDP +5 Fu +BLM )。结果 本组病例总的 5年生存率为 5 0 .74% ,其中单放组和联合组的 5年生存率分别为 48.46%和5 6.80 % (P <0 .0 0 0 1)。用多因素逐步回归分析 ,N分期对生存率的影响最大 (P <0 .0 0 0 1) ;T分期对生存率亦有影响 (P<0 .0 5 ) ;加用化疗能提高生存率 (P <0 .0 0 1)。结论 提示采用根治性放射治疗同期联合化疗对于鼻咽癌的远期疗效似有提高的趋势 ,特别是对于N2、N3的病例。

? Objective To retrospectively analyze the effect of irradiation alone a versus radiotherapy combined with chemotherapy.Methods 895 cases of nasopharyngeal carcinoma were treated from January 1988 to March 1996.Patients were divided into 2 groups,including simple irradiation group receiving only conventional or hyperfractionated radiotherapy by conventional irradiation portals with or without intracavitary brachytherapy to a total dose of 68～79.6Gy;combined group which received the same radiotherapy as simple irradiation group plus concurrent 2～3 cycles of chemotherapy (DDP+5 Fu or DDP+5-Fu+BLM).Results The overall 5 year survival rate of the two group was 50.74%.The 5 year survival rates for radiation alone and combined groups were 48.46% and 56.80%(P<0.0001),respectively.The Cox regression analysis showed that N staging had most prognostic effect on survival (P<0.001);T staging also influenced survival (P<0.05);Survival was increased by combination with chemotherapy (P<0.001).Conclusions Radiotherapy combined with concurrent chemotherapy tended to improve the long term result of nasopharyngeal carcinoma,especially for patients at N2 and N3 stage. 〔