后程加速超分割放疗和同步化疗治疗中晚期鼻咽癌的疗效分析

ANALYSIS ON EFFECT OF ADVANCED NASOPHARYNGEAL CARCINOMA TREATED WITH LATE COURSE ACCELERATED HYPERFRACTIONATION RADIOTHERAPY AND CONCURRENT CHEMOTHERAPY

目的 :观察后程加速超分割放疗和同步化疗治疗中晚期鼻咽癌的疗效。方法 :16 0例 III～ IV期鼻咽癌随机分为常规分割放疗组 (常规组 ) 5 4例、后程加速超分割放疗组 (后加速组 ) 5 8例及后程加速超分割放疗同步化疗组 (综合组 ) 4 8例。常规组照射 2 Gy/次 ,5次 /周 ,总剂量为 70 Gy。后加速组及综合组前 3.5周照射同常规组 ,然后开始照射 1.5 Gy/次 ,2次 /d,间隔 6 h,总量为 6 9Gy。综合组在整个放疗过程中加用化疗 ,每周 1次 ,每次用 DDP2 0～ 30 m g、 5 - Fu5 0 0 m g,静滴 ,共用 6～ 7次。结果 :放疗结束 6个月内鼻咽部肿瘤完全消退率 :后加速组为 6 4.7% ,综合组为 75 .7% ,常规组为 36 .0 % ,后加速组和综合组均明显高于常规组 (P <0 .0 5 )。 1,2 ,3年生存率 :后加速组为 93.1% ,85 .9% ,78.0 % ;综合组为 91.7% ,83.2 % ,78.7% ;常规组为 85 .2 % ,6 9.4% ,5 7.0 % ,后加速组及综合组明显高于常规组 (P <0 .0 5 ) ,而后加速组与综合组的差别无显著性意义 (P >0 .0 5 )。鼻咽部 1,2 ,3年局部控制率 :后加速组为 10 0 .0 % ,10 0 .0 % ,10 0 .0 % ;综合组为10 0 .0 % ,10 0 .0 % ,10 0 .0 % ;常规组为 10 0 .0 % ,92 .3% ,87.7% ,后加速组及综合组明显高于常规组 (P <0 .0 5 )。结论

Objective:To observe the effect of advanced nasopharyngeal carcinoma treated with late course accelerated hyperfractionation radiotherapy and concurrent chemotherapy Methods:A total of 160 patients with stage Ⅲ~Ⅳ nasopharyngeal carcinoma were randomized into three groups: conventional fractionation radiotherapy(CFR) 54 patients,late course accelerated hyperfractionation radiotherapy(LCAHR) 58 patients,late course accelerated hyperfractionation radiotherapy and concurrent chemotherapy (combination group) 48 patients Patients in CFR group received a fraction of 2Gy daily, 5 days per week, to the total dose of 70Gy/7 weeks Patients in LCAHR group and combination group were treated with the same fractionation as those in CFR group to the dose of 36~40Gy, and then followed by late course accelerated hyperfractionation radiotherapy: 1 5Gy, twice daily, with the interval of 6 hours between fractions, to the total dose of 69Gy/6 weeks At the same time, patients in combination group received concurrent chemotherapy in whole course: DDP 20~30mg and 5 Fu 500mg,ivdrop, once a week, to the total of 6~7 times Results:The complete response rate in the nasopharynx was 64 7% in the LCAHR group, 75 7% in the combination group, and 36 0% in the CFR group at the end of the course, they were higher in the LCAHR group and combination group than that in the CFR group(P<0 05) The survival rate and local control rate of one,two,three years were:93 1%?100 0%,85 9%?100 0%,78 0%?100 0%in the LCAHR group,91 7%?100 0%,83 2%?100 0%,78 7%?100 0%in the combination group, and 85 2%?100 0%,69 4%?92 3%,57 0%?87 7%in the CFR group, respectively The survival rates and local control rates of LCAHR group and combination group were higher than that in CFR group(P<0 05) However, the difference between LCAHR group and combination group was not significant (P>0 05)  Conclusions:The results of this study showed that LCAHR radiotherapy can promote disappearance of primary lesion and improve the local control rate and survival rate of patients of stage Ⅲ~Ⅳ nasopharyngeal carcinoma However,there seems to be no benefit to improve the local control rate and the survival rate with the concurrent chemotherapy