Ⅱ期鼻咽癌患者单纯放疗、同步放化疗及同步放化疗联合辅助化疗的预后分析

Prognostic analysis of intensity-modulated radiotherapy alone, concurrent chemoradiotherapy and concurrent chemoradiotherapy combined with adjuvant chemotherapy in patients with stage Ⅱ nasopharyngeal carcinoma

目的通过比较单纯放疗(IMRT)、同步放化疗(CCRT)及同步放化疗联合辅助化疗(CCRT+AC)在Ⅱ期鼻咽癌患者中的生存获益,来探索化疗是否能提高Ⅱ期鼻咽癌患者生存率,为早期鼻咽癌治疗方式的选择提供参考依据。方法回顾性分析2009年10月—2013年10月中南大学湘雅医院肿瘤科收治的122例初治Ⅱ期鼻咽癌患者(T1、2N1M0、T2N0M0,第八版AJCC/UICC鼻咽癌分期标准)的临床资料。其中,IMRT组患者39例,CCRT组患者38例,CCRT+AC组患者45例。主要研究终点为总生存期(OS)、无局部复发生存期(LRFS)、无远处转移生存期(DMFS)及无病生存期(DFS),次要研究终点为毒副反应。结果IMRT组、CCRT组、CCRT+AC组患者5年OS、LRFS、DMFS及DFS比较,差异无统计学意义(P>0.05);但CCRT组、CCRT+AC组患者毒副反应(骨髓抑制、胃肠道反应)较IMRT组更严重(P<0.05)。结论在IMRT基础上加用化疗未能改善Ⅱ期鼻咽癌患者的预后,反而增加毒副反应。

Objective To explore whether chemotherapy can improve the survival rate of patients with stage Ⅱ nasopharyngeal carcinoma, and provide a reference for the choice of treatment methods for early nasopharyngeal carcinoma by comparing the survival benefit of three kinds of treatment methods: intensity-modulated radiotherapy alone(IMRT), concurrent chemoradiotherapy(CCRT) and concurrent chemoradiotherapy combined with adjuvant chemotherapy(CCRT+AC) for stage Ⅱ nasopharyngeal carcinoma Methods The clinical data of 122 patients with nasopharyngeal carcinoma treated with tumor in Xiangya Hospital from October 2009 to October 2013 were analyzed retrospectively(T1-2 N1 M0, T2 N0 M0, eighth edition of AJCC/UICC nasopharyngeal carcinoma staging standard). There were 39 patients in the IMRT group, 38 patients in the CCRT group, and 45 patients in the CCRT+AC group. The primary endpoints were overall survival(OS), no local recurrence survival(LRFS), no distant metastasis survival(DMFS), and disease-free survival(DFS). The secondary endpoint was toxicities. Results There was no significant difference in 5-year OS, LRFS, DMFS and DFS among the IMRT group, CCRT group and CCRT+AC group(P > 0.05). However, the side effects(bone marrow suppression, gastrointestinal reaction) in the CCRT group and the CCRT+AC group were more serious than those in the IMRT group alone(P < 0.05). Conclusions On the basis of IMRT combined with chemotherapy failed to improve prognosis of stage Ⅱ nasopharyngeal carcinoma. However, it increases adverse reaction.