单纯IMRT或IMRT联合同期化疗对T3N0M0期鼻咽癌患者生存期和严重急性毒性的影响

IMRT treatment or IMRT treatment combined with chemotherapy for stage T3N0M0 surial in patients with nasopharyngeal carcinoma and the impact of severe acute toxicity

目的分析单一适形调强放射治疗(IMRT)或IMRT联合同期化疗对T3N0M0期鼻咽癌患者生存期和严重急性毒性反应的影响。方法回顾性分析甘肃省武威肿瘤医院收治的94例T3N0M0期鼻咽癌患者的临床资料,根据治疗方式的不同,分为A组(单一IMRT组) 38例和B组(IMRT联合同期化疗) 56例。分别采取相应方法治疗。比较两组患者临床病理特征;两组患者无瘤生存和总生存情况;多因素Logistic回归分析影响患者总生存率以及急性毒性反应的发生情况。结果 B组治疗前血浆EB病毒(EBV) DNA含量≥4 000 copies/ml的比率较A组明显升高(P <0. 05)。两组患者鼻咽大体肿瘤体积(GTV-P)比较,存在显著差异(P <0. 05)。两组患者3年无瘤生存率和总生存率的比较,并无显著差异(P>0. 05)。多因素Logistic回归分析发现,治疗前血浆EBV DNA含量是影响患者总生存率的相关因素(P <0. 05)。B组治疗期间出现严重(分级Ⅲ~Ⅳ度)急性毒性反应(粒细胞减少、白细胞减少、口腔黏膜炎、胃肠道反应)的发生率较A组明显升高(P <0. 05)。结论采取IMRT的T3N0M0期鼻咽癌患者联合同期化疗并不会起到延长生存期的效果,反而会明显提高部分严重急性毒性反应的发生率,如粒细胞减少、白细胞减少、口腔黏膜炎、胃肠道反应等,因此患者行IMRT治疗的同时是否需要联合化疗值得进一步分析。

Objective To analyze intensity modulated radiation therapy( IMRT) treatment or combined in the same period of chemotherapy for stage T3 N0 M0 surial in patients with nasopharyngeal carcinoma and the impact of severe acute toxic effects. Methods A retrospective analysis was performed,the clinical data of 94 patients with nasopharyngeal carcinoma stage T3 N0 M0 in our hospital was selected. According to the different methods of treatment,94 cases were divided into group A( received IMRT) with 38 cases and group B( IMRT combined chemotherapy in the same period) with 56 cases. The clinical and pathological characteristics of the patients were compared;the tumor-free survival and overall survival of the patients were reduced;multivariate logistic regression analysis affected the overall survival rate of patients and the occurrence of acute toxicity. Results The proportion of plasma Epstein-Barr virus( EBV) DNA content ≥4 000 copies/ml in group B was significantly higher than that in group A( P < 0. 05). There was significant difference between the two groups in gross tumor volume of the primary( GTV-P)( P< 0. 05). There was no significant difference in 3-year tumor-free survival rate and overall survival rate between the two groups( P > 0. 05).Multivariate Logistic regression analysis showed that plasma EBV DNA content before treatment was a relevant factor affecting the overall survival rate of patients( P < 0. 05). The incidence of severe( grade Ⅲ ~ Ⅳ) acute toxic reactions( granulocytopenia,leukopenia,oral mucositis,and gastrointestinal reactions) during treatment in group B was significantly higher than that in group A( P < 0. 05). Conclusion IMRT treatment in the same period of chemotherapy in patients with nasopharyngeal carcinoma stage T3 N0 M0 can’t prolong survival,but it will obviously increase the incidence of severe acute toxic effects,such as granulocytopenia,leukopenia,inflammation of the oral mucosa,gastrointestinal reaction and so on,so it is worth further analysis for the combination application of MDT and IMRT treatment.