局部晚期鼻咽癌替吉奥化疗同步放疗临床观察

S-1 joint synchronization efficacy of radiation therapy for patients with locally advanced nasopharyngeal carcinoma

目的：观察替吉奥联合同步放疗在局部晚期鼻咽癌患者中的应用效果及安全性。方法：选取2008—01-01—2010—01—01宁津县人民医院（40例）和山东大学附属省立医院（55例）收治的95例局部晚期鼻咽癌患者作为研究对象。根据单纯随机分配原则分为观察组和对照组，其中观察组54例为替吉奥化疗联合同步放疗；对照组41例为单纯接受放疗，观察两组患者治疗效果及不良反应发生率，比较两组患者的复发情况及生存状况。结果：共90例患者可评价疗效及不良反应。临床有效率观察组为88．24％，对照组为48．72％，两组比较差异有统计学意义，P〈O．01。观察组患者胃肠道反应发生率为45．10％，显著高于对照组的20．51％，P=0．013；观察组骨髓抑制发生率为47．06％，显著高于对照组的17．95％，P=0．003；但胃肠道反应、骨髓抑制均为I～Ⅱ度，患者可以耐受。观察组口腔黏膜反应发生率为82．35％，与对照组的82．05％比较，差异无统计学意义，P=0．592；放射性皮炎发生率为82．35％，与对照组的84．62％相比，差异无统计学意义，P=0．503。观察组患者治疗后1年生存率为98．04％，与对照组的97．44％比较，差异无统计学意义，P=0．682，但复发率（1．96％）显著低于对照组（15．38％），差异有统计学意义，P=0．024。治疗后第2年，观察组的生存率为98．04％，显著优于对照组84．61％，P=0．024；3年生存率观察组为96．08％，显著高于对照组的79．49％，P=0．016。2年复发率观察组为3．92％，显著低于对照组的17．95％，P=0．0393；3年复发率观察组为9．80％，显著低于对照组的25．64％，P=0．044。结论：对局部晚期鼻咽癌患者采用替吉奥联合同步放疗，效果显著，可以更好推广应用于临床治疗。

OBJECTIVE：To analyze and investigate the effectiveness and safety of S-1 joint concurrent radiotherapy in patients with advanced nasopharyngeal. METHODS： The 95 cases of locally advanced NPC patients were selected in the hospital for the study from January 2008 to January 2010. According to the simple random allocation,54 cases were divided into the observation group with the treatment of S-1 joint chemotherapy concurrent radiotherapy,and the other 41 patients were divided into the control group with the treatment of radiotherapy alone. To observe the therapeutic effect of the two groups of patients, and the incidence of adverse reactions, the recurrences and living conditions of the patients were in- vestigated by three-years follow up after discharge. RESULTS： A total of 90 patients can be used to evaluate curative effect and adverse reaction,and the clinical effective rate was the CR（complete remission） and PR（partial remission） patients accounting the ratio of total numbers. In observation group the clinical effective rate was 88.24% while the control group was 48.72%. The clinical efficiency was statistically significant （P〈0.01） between the two groups. Gastrointestinal reaction and bone marrow suppression rate of the observation group patient was 45.10% and 47.06 %,while the control group was 20.51% and 17.95%, which was significantly higher than that of the control group （P were 0. 013 and 0. 003）. The gastrointestinal reaction and bone marrow suppression were grade I -- Ⅱ which was tolerable for the pa tients. The incidence rate of oral mucosa reaction and radioactive dermatitis in observation group were both 82. 35% compared with the control group＇s 82. 05% and 84. 62% respectively. P value was 0. 592 and 0. 503, which was not statistically significant （P were 0. 592 and 0. 503）. There was no difference in 1-year survival between observation group patient （98. 04%） after treatment and control group （97.44%）, P value was 0. 682. The relapse rate（1. 96%） in observation group was significantly lower than that of the control group（15.38%） after treatment with the P value of 0. 024. In the second year and the third year, the survival rate of the observation group （98.04%, 84.61% ） was significantly better than that ot the control group （96. 08%,79.49%） with the P value of 0. 024 and 0. 016 respectively. The recurrence rate （3. 92%,9.80 % ） in observation group was significantly lower than that of the control group （17.95%, 25.64%） with the P value of 0. 039 3 and 0. 044 respectively. CONCLUSIONS： The effect of combination S-1 concurrent radiotherapy on the locally advanced NPC patients is significant and worthy of clinical application.