摘要
目的 评价新辅助化疗加后程加速超分割放疗治疗鼻咽癌的近期疗效及急性放射反应。方法 将同期收治的 4 3例经病理确诊且无远处转移的鼻咽癌患者随机分为研究组 (n=2 3)和对照组 (n=2 0 )。研究组先按 FP方案 (5 - Fu+DDP)行 1周期新辅助化疗 ,然后行放疗。放疗又分两个阶段 ,首先设面颈联合野加下颈切线野 ,行常规分割放疗 ,照射 36 .0～ 4 0 .0 Gy后缩野 ,而后改用面颈分野 ,研究组行加速超分割放疗 ,每次 1.4～ 1.6 Gy、每日 2次 ,间隔时间≥ 6小时 ,鼻咽部总剂量照射至 6 8.0～ 70 .0 Gy;对照组仅行常规分割放疗 ,鼻咽部总剂量照射至6 8.0～ 70 .0 Gy。放疗结束后 1月 ,两组再行 3～ 4周期辅助化疗 ,方案同前。结果 研究组口腔粘膜急性放射反应较对照组重 (P<0 .0 5 ) ,而皮肤和血液学急性放射反应两组无显著性差异 (P>0 .0 5 )。放疗结束时 CT检查显示两组鼻咽部和颈部肿瘤的完全消退率分别为 78.2 6 %和 6 5 .0 0 % ,无显著性差异 (P>0 .0 5 )。但在放疗结束后 3个月和 6个月 ,两组鼻咽癌和颈部肿瘤的完全消退率分别为 95 .6 5 %比 70 .0 0 %及 95 .6 5 %比 75 % ,均有显著性差异 (P<0 .0 5 )。放疗结束后 6个月 ,两组中、晚期 ( 期 + A+ B期 )病例肿瘤的完全消退率分别为 92 .31%和 5 0 .0 0 %
Objective To evaluate the preliminary therapeutic efficacy and acute radiation toxicity of neoadjuvant chemotherapy plus late course hyperfractionated accelerated radiation therapy (LCHART) in the treatment of nasopharyngeal carcinoma (NPC). Methods Forty three in patients with pathological diagnosis of nonmetastatic (M0) NPC from September 1999 to September 2000 were randomized into two groups: one was treated by neoadjuvant chemotherapy followed by LCHART (study group, n =23); the other was treated by conventional fractionation radiotherapy (control group, n =20); additionally, adjuvant chemotherapy given repeatedly every 3 weeks for 3 4 cycles to both groups was initiated 1 month after radiotherapy. The chemotherapy included Cisplatin 30mg/m 2 d1 3 and 5 Fu 500mg/m 2 d1 5. The radiotherapy (RT) consisted of two phases: 36 0 40.0Gy in 18 20 fraction over 3.5 4 weeks as phase I RT using conventional technique was delivered with two lateral opposing faciocervical fields and an anterior field of lower neck in the two groups, and then 28.0 32.0Gy in 20 fraction over 2 weeks was administered as phase II RT using LCHART technique (1.4 1.6Gy per fraction, twice daily with interval ≥6 hours) in the study group and the same doses using conventional radiation technique (2.0Gy per fraction once daily) in the control group to the primary tumor with the shrinking field (two lateral opposing facial fields) to avoid excessive irradiation to the spinal cord. Results All study patients went through completely the therapeutic regimen without interruption of radiotherapy. LCHART was associated with significantly more severe mucositis (grade 3 4 oral mucositis was 47.8%), compared with that of 20% in the conventional fractionation radiotherapy ( P <0.05). No significant difference in acute toxicity of skin and hematology was seen between LCHART and conventional fractionation radiotherapy ( P >0.05). The nasopharyngeal and cervical lesion complete response rate was 78.26% for the treatment group and 65.00% for the control group ( P >0.05) at the end of immediately after radiotherapy. Three months and six months after radiotherapy, the tumor complete response rates were 95.65% vs 70.00% ( P <0.05) and 95.65% vs 75 00%( P <0.05) respectively between the study group and control group. Six months after radiotherapy, the tumor complete response rate of locally advanced NPC was 92.13% for the study group and 50.00% for the control group ( P <0.05). Conclusion In comparison with conventional fractionation radiotherapy, neoadjuvant chemotherapy plus LCHART has the advantage of bringing NPC under local control, especially in locally advanced NPC, and its acute radiation toxicity is tolerable.
出处
《华西医科大学学报》
CSCD
北大核心
2002年第4期632-635,共4页
Journal of West China University of Medical Sciences
关键词
化疗
后程加速超分割放疗治疗
鼻咽癌
临床研究
Nasopharyngeal carcinoma Neoadjuvant chemotherapy Late course hyperfractionated accelerated radiation therapy
