调强放疗模式下诱导化疗联合同期放化疗对鼻咽癌患者的临床疗效分析

Analysis of the Effect of Induced Chemotherapy Combined with Concurrent Chemoradiotherapy on the Clinical Efficacy of Nasopharyngeal Carcinoma Patients under the Mode of Intensity Modulated Radiotherapy

目的探讨调强放疗(IMRT)模式下诱导化疗联合同期放化疗对鼻咽癌(NPC)患者的临床疗效。方法回顾性分析NPC初诊患者133例的临床资料,其中进行诱导化疗以后再进行同期放化疗者68例,为观察组;进行诱导化疗以后进行放疗者65例,为对照组。2组均进行根治性剂量的IMRT。患者在放疗前都进行诱导化疗,诱导化疗均应用双药结合TP方案(铂类结合紫杉醇)和同期化疗为单药铂类。观察2组患者近期治疗效果、生存状况及不良反应情况。结果 2组患者颈部转移灶与鼻咽原发灶治疗有效率均为100. 0%,对比差异无统计学意义(P> 0. 05)。2组患者1年、2年OS及PFS对比差异无统计学意义(P> 0. 05)。观察组3～4级白细胞下降、口咽黏膜炎发生率高于对照组,差异有统计学意义(P <0. 05)。结论同期放化疗并不能为IMRT治疗模式下NPC患者带来更多益处,反而会增加患者不良反应发生率。

Objective To investigate the clinical efficacy of induction chemotherapy combined with concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma( NPC) under IMRT mode. Methods The clinical data of 133 newly diagnosed NPC patients were retrospectively analyzed. Sixty-eight patients who underwent concurrent chemoradiation after induction chemotherapy were observation groups. Sixty-five patients who underwent radiotherapy after induction chemotherapy were control subjects. Radical dose of IMRT was performed in both groups. All patients received induction chemotherapy before radiotherapy.Induction chemotherapy was performed using dual drugs combined with TP regimen( platinum combined with paclitaxel) and concurrent chemotherapy as single agent platinum. Observe the short-term treatment effect,survival condition and adverse reactions of the two groups of patients. Results The effective rates of cervical metastases and nasopharyngeal primary lesions in both groups were 100. 0%. There were no PD and SD patients,and the difference was not statistically significant( P > 0. 05). There was no significant difference in OS and PFS between the two groups at 1 year and 2 years( P > 0. 05). The incidence of white blood cell decline and oropharyngeal mucositis at the 3 rd to 4 th level in the observation group was higher than that in the control group,and the difference was statistically significant( P < 0. 05). Conclusion Concurrent radiotherapy and chemotherapy can not bring more benefits to NPC patients in the IMRT treatment mode,but will increase the incidence of adverse reactions in patients.