微波热疗联合放化疗治疗鼻咽癌N2和N3期颈部淋巴结转移患者的疗效观察

Short-term effect of 42 N2 and N3 nodal nasophayngeal carcinoma treated with thermotherapy and intensity modulated radiation therapy

目的探讨微波热疗联合放化疗治疗N2、N3期鼻咽癌颈部淋巴结转移患者的近期疗效。方法将95例N2~N3期、无放化疗及热疗禁忌证的鼻咽癌初治患者随机分为放化热疗组（42例）及放化疗组（53例）。两组均采用瑞典ELEKTA5933型直线加速器,8 MV X线行鼻咽、颈部调强适形放疗（IMRT）根治性外照射,设野及剂量基本相同;化疗采用DDP（20 mg/m^2）、5-Fu（2200 mg/m^2）和四氢叶酸（120mg/m^2）24h灌注,诱导后单药顺铂（DDP方案）与放疗同一天开始,之后3周重复,共3个周期;热疗采用KJ-9000型微波肿瘤热疗仪行颈部淋巴结透热,45-60 min/次,2次/周,6-8次。结果放化热疗组和放化疗组的颈部淋巴结治愈成功率分别为100%和88.7%,差异有统计学意义（P〈0.05）。分层分析显示,两组N3期患者的疗效差异有统计学意义,而N2期患者差异则无统计学意义（P〉0.05）。结论临床治疗鼻咽癌N2、N3期颈部淋巴结转移患者中,微波热疗联合放化疗的治疗效果更显著,尤其对于N3期患者而言,效果更佳,应在临床治疗中推广使用。

Objective To investigate the efficacy of thermotherapy combined with intensity modulated radiation therapy （IMRT） and concurrent chemotherapy for patients with N2 and N3 nodal nasophayngeal carcinoma. Methods The clinical data from 95 untreated patients with N2 and N3 nasopharyngeal carcinoma and without any contraindication of radiotherapy, chemotherapy, and thermotherapy were collected. 42 patients were randomized to accept thermotherapy combined with IMRT and concurrent chemotherapy, while other 51 patients accepted concomitant radiotherapy and chemotherapy. Radiotherapy was delivered using ELEKTA5933 equipment （8 MV linear accelerator）. Chemotherapy generally consisted of PF （5-Fu ＋ DDP） or TP （PTX ＋ DDP） regiment induction chemotherapy and thereafter DDP concurrent chemotherapy on day 1, 22 and 43 of radiotherapy. Thermotherapy was given with the schedule （45-60 min per time, 2 times per week, 6 to 8 times） through KJ-9000 microwave Hyperthermia equipment made by NOVA Medical Instrument Co. , Ltd. Results Curative success rates of cervical lymph nodes in radiochemical therapy group and chemotherapy group patients were 100% and 88. 7% respectively, with statistical significance difference （P 〈 0. 05）. Stratified analysis showed that effect is significant differences mainly display in lymph node stage N3 patients, and for N2 patients no significant differences between the two groups. Conclusion In the clinical treatment of nasopharyngeal carcinoma N2, cervical lymph node N3 node metastasis patients, treatment effect with microwave hyperthermia combined with radiotherapy is more significant, especially for stage N3 patients. The effect is better, and should be popularized in clinical treatment.