局部晚期鼻咽癌同期三维适形调强放疗和时间调节式化疗的临床研究

Clinical research on three-dimensional intesity-modulated radiotherapy combined with chrono-chemotherapy for locally advanced nasopharyngeal carcinoma

目的：探讨局部晚期鼻咽癌同期三维适形调强放疗和时间调节式化疗的临床疗效及预后情况。方法选取2008年1月至2010年3月106例经病理学确诊的Ⅲ、Ⅳa期鼻咽癌患者，按数字随机法分为观察组56例和对照组50例，两组均给予等量的顺铂＋氟尿嘧啶＋亚叶酸钙的化疗方案，观察组采用快速泵注化疗药物方式，持续12 h，而对照组每天按常规输液速度输注化疗药物，持续24 h，随后两组均给予三维适形调强放疗，疗程为6周，比较两组肿瘤的缓解率、有效率、不良反应以及随访1~3年的局部控制率和无转移生存率。结果疗程结束后，观察组的完全缓解率及总有效率为46.43%和94.64%，明显高于对照组的36.00%和80.00%，差异有统计学意义（P〈0.05）；在随访3年过程中，观察组每年获得随访的例数分别为54例、46例和41例，而对照组每年获得随访的例数分别为48例，45例和38例。两组1年后的局部控制率、无转移生存率差异无统计学意义（P〉0.05），但观察组2年、3年后的局部控制率、无转移生存率明显优于对照组（P〈0.05）；而两组放化疗后的不良反应主要为放射性咽喉炎、皮炎和白细胞减少等，其中两组均以白细胞下降最为明显，观察组白细胞下降的发生率明显低于对照组，但3度以上放射性咽喉炎情况却比对照组严重，差异均具有统计学意义（P〈0.05）。结论局部晚期鼻咽癌选择同期三维适形调强放疗和时间调节式化疗具有较好的近、远期疗效，且治疗后的不良反应及毒副作用较一般放化疗低，值得临床作进一步研究。

Objective To dicuss the clinical effect and prognosis of three-dimensional intesity-modulated radio-therapy combined with chrono-chemotherapy for locally advanced nasopharyngeal carcinoma （NPC）. Methods From January 2008 and March 2010, 106 patients diagnosed withⅢ,Ⅳa locally recurrent NPC by biopsy and/or CT/MRI evidence of progressive skull base erosion and clinical symptoms were randomly divided into the observation group （n=56） and the control group （n=50）. Two groups both received chemotherapy regimens of DDP＋5-FU/CF. The obser-vation group used rapid pump chemotherapy drug injection method, over 12 hours, and the control group received che-motherapy drugs according to the conventional infusion speed, over 24 hours. Then the two groups received three-di-mensional intesity-modulated radiotherapy for 6 weeks. The tumor response rate, efficient rate, adverse reactions, the 1~3-year local control rate, and the metastasis-free survival rate were compared between the two groups. Results Af-ter the treatment, the complete remission （CR） rate and total effective rate of the observation group were 46.43%and 94.64%, significantly higher than those of the control group （36.00%and 80.00%, P〈0.05）. During the follow-up of 3 years, the number of the patients followed each year were 54, 46, 41 in the observation group, and 48, 45, and 38 in the control group, respectively. The 1-year local control rate and metastasis-free survival rate of the two groups showed no statistically significant differences （P〉0.05）, but the 2-year and 3-year local control rate and metasta-sis-free survival rate of the observation group were significantly better than those of control group （P〈0.05）. The ad-verse reactions of the two groups were radioactive sore throat, dermatitis and hypoleucocytosis, of which hypoleucocy-tosis was the most serious in two groups. The incidence of hypoleucocytosis of the observation group was significant-ly lower than that of the control group, but the≥3 degrees radioactive sore throat in the observation group was seri-ous than that in the control group （P〈0.05）. Conclusion For locally advanced nasopharyngeal carcinoma, three-di-mensional intesity-modulated radiotherapy combined with chrono-chemotherapy has good short-term effect and long-term effect, and adverse reactions and side effects after treatment are lower than those of general chemoradiation, which worth for further study in clinical practice.