广东地区局部晚期鼻咽癌患者IMRT联合化疗的初步临床研究

Preliminarily Clinical Study of Locally Advanced Nasopharyngeal Carcinoma with Intensity Modulated Radiation Therapy Combined with Chemotherapy in Guangdong District

目的比较IMRT联合化疗治疗局部晚期鼻咽癌临床疗效和不良反应。方法对2007—2010年间收治的符合入组标准的280例鼻咽癌患者随机均分为实验组和对照组,实验组采用同期放化疗和新辅助化疗方案治疗,对照组采用单纯放疗方案治疗。结果治疗后3年内复发24例(观察组5例,对照组19例);远处转移19例(观察组4例,对照组15例),3年内死亡19例(全为对照组),两组患者差异有统计学意义(P<0.05);治疗期间急性不良反应包括皮肤发射损伤及恶心呕吐50例(实验组35例,对照组15例),白细胞减少160例(实验组102例,对照组58例),两组患者差异有统计学意义(P<0.05)。治疗后1年主要不良反应为皮下软组织纤维化68例(实验组32例,对照组36例),放射性脑病8例(实验组3例,对照组5例),两组患者差异无统计学意义(P>0.05)。结论采用同期放化疗及新辅助化疗可显著提高局部晚期鼻咽癌患者的远期生存率,虽然急性不良反应发生率较单纯放疗高,但远期不良反应相近。

Objective To observe and compare the clinical curative effect and adverse reactions of IMRT combined with chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Methods 280 patients with nasopharyngeal carcinoma who met the inclusion criteriain and admitted from 2007 to 2010 were randomly and equally divided into the experimental group and the control group. The experimental group was treated with concurrent chemoradiotherapy and neoadjuvant chemotherapy, while the control group was treated with radiation therapy. Results Within 3 years after treatment, there were 24 cases with recurrence（5 cases in the observation group, 19 cases in the control group）; 19 cases with distant metastasis（4 cases in the observation group, 15 cases in the control group）, 19 cases died in these 3 years（all in the control group）, the difference between the two groups was statistically significant（P〈0.05）; the acute adverse reactions during the treatment included 50 cases with radiation injury of skin and nausea and vomiting（35 cases in the experimental group, 15 cases in the control group）, 160 cases with leucopenia（102 cases in the experimental group, 58 cases in the control group）, the difference between the two groups was statistically significant（P〈0.05）. The adverse reactions 1 year after treatment mainly were 68 cases with subcutaneous soft tissue fibrosis（32 cases in the experimental group, 36 cases in the control group）, 8 cases with radiation encephalopathy（3 cases in the experimental group, 5 cases in the control group）, the difference between the two groups was not statistically significant（P〉0.05）.Conclusion For patients with locally advanced nasopharyngeal carcinoma, concurrent chemoradiotherapy and neoadjuvant chemotherapy can significantly improve the long-term survival rate, although the incidence of acute adverse reactions of which is higher than that of radiotherapy alone, the long-term adverse reactions of the two treatment methods are similar.