调强适形放疗对鼻咽癌患者治疗效果及免疫功能的影响

The clinical efficacy of IMRT and the influence on immune function of patients with nasopharyngeal carcinoma

目的探讨调强适形放疗(IMRT)对鼻咽癌患者的治疗效果及对免疫功能的影响。方法选取拟实施IMRT的84例鼻咽癌患者为观察组,选取30例健康者为对照组。观察鼻咽癌患者化疗后的近期疗效,并对观察组治疗前后和对照组外周血淋巴细胞亚群及血清免疫球蛋白水平进行比较。结果 84例接受IMRT的患者中,完全缓解(CR)31例(36.9%),部分缓解(PR)30例(35.7%),疾病稳定(SD)14例(16.7%),疾病进展(PD)9例(10.7%),缓解率为72.6%,疾病控制率为89.3%。放疗后,观察组患者的肿瘤靶体积较放疗前降低(P﹤0.05)。放疗前后,观察组的外周血CD3+T细胞、CD4+T细胞、CD4+/CD8+T细胞水平均低于对照组,CD8+T细胞、自然杀伤(NK)细胞水平均高于对照组,差异均有统计学意义(P﹤0.05);放疗后,观察组患者的外周血CD3+T细胞、CD4+T细胞、CD4+/CD8+T细胞水平均较本组放疗前降低,CD8+T细胞水平较本组放疗前升高,差异均有统计学意义(P﹤0.05);放疗前后,观察组患者的血清免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平均低于对照组(P﹤0.05);放疗后,观察组患者的血清IgG、IgM水平与本组放疗前比较,差异均无统计学意义(P﹥0.05)。结论 IMRT对鼻咽癌患者的治疗效果肯定,但是对患者的免疫功能具有一定的损伤作用。

Objective To investigate the clinical efficacy of intensity modulated radiation therapy (IMRT) for patients with nasopharyngeal carcinoma and the effect on immune function. Method A total of 84 cases of nasopharyngeal carcinoma patients administered with IMRT were included as study group, and another 30 healthy subjects were recruited as control group, the short- term efficacy in nasopharyngeal cancer patients after chemotherapy were observed, furthermore, the changes of peripheral blood lymphocyte subsets and serum immunoglobulin level between study group before and after treatment and control group were observed and compared. Result Of the 84 cases receiving IMRT, there were 31 cases (36.9%) of complete response (CR), 30 cases (35.7%) of partial response (PR), 14 cases (16.7%) of stable disease (SD), and 9 cases (10.7%) of progression disease (PD), the remission rate was 72.6% and the disease control rate was 89.3% in these patients. After chemotherapy, the tumor target volume in study group was decreased significantly compared with that before chemotherapy (P<0.05). Before and after radiotherapy, the peripheral blood level of CD3^+ T cell, CD4^+ T cell, CD4^+/CD8^+ T cell were significantly lower in study group than in control group (P<0.05), while the peripheral blood level of CD8^+ T cell and NK cell were higher in study group than that in control group (P<0.05);after radiotherapy, the peripheral blood level of CD3^+ T cell, CD4^+ T cell, and CD4^+/CD8^+ T cell in the study group were significantly reduced in comparison with those before radiotherapy (P<0.05), though CD8^+ T cell was significantly elevated (P< 0.05);before and after radiotherapy, the serum immunoglobulin G (IgG) and immunoglobulin M (IgM) level were significantly lower in study group compared with that in control group, the difference was statistically significant (P<0.05);after radiotherapy, the serum IgG and IgM in study group were not significantly different from that before radiotherapy (P> 0.05). Conclusion IMRT is therapeutically effective for patients with nasopharyngeal carcinoma, though the cellular immune function may be compromised to some degree.