后程加速超分割放疗联合化疗治疗Ⅲ、Ⅳa期鼻咽癌的临床研究

Late Course Accelerated Hyperfractionated Radiotherapy Combined withChemotherapy for Stage Ⅲ and Ⅳa Nasopharyngeal Carcinoma

目的:研究后程加速超分割放疗联合化疗治疗Ⅲ、Ⅳa期鼻咽癌的疗效。方法:将100例Ⅲ、Ⅳa期鼻咽癌随机分为后程加速超分割放疗联合化疗组及常规分割放疗联合化疗组。后程加速超分割放疗联合化疗组于放疗前先行诱导化疗2次;化疗后先行常规分割放疗至鼻咽部剂量为40Gy,缩野后行后程加速超分割放疗至鼻咽部总剂量为70Gy;于放疗结束后再行辅助化疗2次。常规分割放疗联合化疗组化疗方法与后程加速超分割放疗联合化疗组相同;放疗采用常规分割,鼻咽部总剂量为70Gy。结果:后程加速超分割放疗联合化疗组及常规分割放疗联合化疗组的2年实际生存率分别为83.6%及79.7%(P>0.05);2年无瘤生存率分别为76.5%及59.1%(P<0.05);2年局部区域无复发生存率分别为90.0%及69.7%(P<0.05)。后程加速超分割放疗联合化疗组有2例出现放射性后组脑神经损伤,常规分割放疗联合化疗组无严重后期并发症。结论:后程加速超分割放疗联合化疗较常规分割放疗联合化疗提高了Ⅲ、Ⅳa期鼻咽癌的2年局部区域无复发生存率及2年无瘤生存率,但增加了后期并发症的发生率,其长期疗效及后期不良反应有待进一步随访观察。

Objective: To evaluated the treatment results of late course accelerated hyperfractionated radiotherapy combined with chemotherapy for Stage Ⅲ and Ⅳa nasopharyngeal carcinoma. Methods: One hundred patients with Stage Ⅲ and Ⅳa nasopharyngeal carcinoma were randomized into two groups. The late course accelerated hyperfractionated radiotherapy combined with chemotherapy group received the induction chemotherapy for two cycles, followed by conventional fractionation radiotherapy to a dose 40 gray, than changed into accelerated hyperfractionated radiotherapy to a total dose of 70 gray, and used another two cycles of adjuvant chemotherapy. The conventional fractionation radiotherapy combined with chemotherapy group received the chemotherapy that it similar to the late course accelerated hyperfractionated radiotherapy combined with chemotherapy group, and used the conventional fractionation radiotherapy to a total dose of 70 gray. Results: The 2 year overall survival rate were 83.6% in late coursed with accelerated hyperfractionated radiotherapy combine chemotherapy group and 79.7% in conventional fractionation radiotherapy combined with chemotherapy group, had no significant difference (P >0.05). The 2 year disease free survival rate were 76.5% in late course accelerated hyperfractionated radiotherapy combined with chemotherapy group and 59.1% in conventional fractionation radiotherapy combined with chemotherapy group (P< 0.05). The 2 year local regional free recurrence rate were 90.0% in late course accelerated hyperfractionated radiotherapy combined with chemotherapy group and 69.7% in conventional fractionation radiotherapy group (P< 0.05). There were the cranial nerves complications in two patients of the late course accelerated hyperfractionated radiotherapy combined with chemotherapy group. Conclusions: The results from this study show that the 2 year disease free survival rate and the 2 year local regional free recurrence rate in late course accelerated hyperfractionated radiotherapy combined with chemotherapy group was significant better than in conventional fractionation radiotherapy group, but the radiation induced damage to the cranial nerves was improved in late course accelerated hyperfractionated radiotherapy combined with chemotherapy group, the long term survival rate and the late complication need follow up further.