调强放疗联合化疗治疗Ⅲ期及Ⅳa期鼻咽癌临床观察
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摘要
目的 :研究临床Ⅲ期及Ⅳa期初治鼻咽癌患者调强放疗联合化疗的临床疗效及急慢性不良反应。方法 :对40例Ⅲ期、IVa期初治鼻咽癌患者行调强放疗,配合以铂类为基础的全身化疗。结果 :早期不良反应多为1、2级放射性口腔黏膜炎(85%)和1、2级皮肤放射反应(87.5%),患者可耐受。晚期不良反应为口干为主,随着治疗后时间的延长,口干症状逐渐减轻。中位随访时间为40个月,1、3总生存率为95%,85.9%。1、3年局部区域控制率97.4%,91.6%。1、3无远处转移生存率97.4%,81.5%。结论 :调强放疗联合铂类化疗使得Ⅲ期及Ⅳa期鼻咽癌患者的局部区域控制率和总生存率得到了提高,局部区域控制率提高最为显著,不良反应可以耐受,生活质量得到明显的改善。
Purpose To study the clinical efficiency and the acute and late normal tissue toxicities of Stage Ⅲ and stage Ⅳa untreated nasopharyngeal carcinoma patients treated by intensity modulated radiation therapy(IMRT) with chemotherapy. Methods A total of 40 patients untreated NPC patients received IMRT with platinum-based chemotherapy. Results The incidences of acute grade 1 and grade 2 toxicity of mucous and skin were 85%, 87.5%, respectively and the acute toxicities were tolerable.The main late toxicity was xerostomia decreased with time going. The median follow-up interval was 40 month(3-80months). The 1-year and 3-years overall survival rate were 95%, 85.9%. The local-regional control rates were 97.4%, 91.6%. and the l-year and 3-year disease metastasis-free were 97.4%, 81.5%, respectively. Conclusions IMRT combined platinum-based chemotherapy was an effective treatment and could get good overall survival and local-regional free survival for Stage Ⅲand stage Ⅳa untreated nasopharyngeal carcinoma(NPC)patients. The toxicities were slight and tolerable.
Purpose To study the clinical efficiency and the acute and late normal tissue toxicities of Stage Ⅲ and stage Ⅳa untreated nasopharyngeal carcinoma patients treated by intensity modulated radiation therapy(IMRT) with chemotherapy. Methods A total of 40 patients untreated NPC patients received IMRT with platinum-based chemotherapy. Results The incidences of acute grade 1 and grade 2 toxicity of mucous and skin were 85%, 87.5%, respectively and the acute toxicities were tolerable.The main late toxicity was xerostomia decreased with time going. The median follow-up interval was 40 month(3-80months). The 1-year and 3-years overall survival rate were 95%, 85.9%. The local-regional control rates were 97.4%, 91.6%. and the l-year and 3-year disease metastasis-free were 97.4%, 81.5%, respectively. Conclusions IMRT combined platinum-based chemotherapy was an effective treatment and could get good overall survival and local-regional free survival for Stage Ⅲand stage Ⅳa untreated nasopharyngeal carcinoma(NPC)patients. The toxicities were slight and tolerable.
引文
[1]郭戈杨,罗英,李宇,等.白介素11联合地塞米松治疗急性放射性口腔炎的临床观察[J].湖南师范大学学报(医学版),2013,10(4):86-88.
[2]赵充,韩非,卢丽霞,等.调强适形放射治疗对局部晚期鼻咽癌的临床疗效[J].癌症,2004,23(z1):1532-1537.
[3]Kam Michael K M,Teo Peter M L,Chau Ricky M C,et al.Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy:the Hong Kong experience[J].International journal of radiation oncology,biology,physics,2004,60(5):1440-1450.
[4]舒禹先,敖帆,吴志瑛,等.鼻咽癌调强放射治疗联合化疗的初步临床分析[J].实用癌症杂志,2014,29(08):946-950.
[5]黄生富,朱向帜,许建华,等.116例鼻咽癌一体化照射野调强放疗的疗效分析[J].临床肿瘤学杂志,2010,15(10):895-899.
[6]胡福军,陈晓钟,姜锋,等.局部晚期鼻咽癌调强放疗联合化疗135例临床分析[J].中华肿瘤防治杂志,2012,19(12):917-920.
[7]韩露,林少俊,潘建基,等.305例鼻咽癌调强放疗预后因素分析[J].癌症,2010,29(2):153-158.
[8]Shaojun Lin,Jiade Jay Lu,Lu Han,et al.Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma:Experience of 370 consecutive cases[J].BMC cancer,2010,10(1):39-
[9]J A Langendijk,C R Leemans,J Buter,et al.The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma:a meta-analysis of the published literature.[J].Journal of clinical oncology,2004,22(22):4604-4612.
[10]P.Y.Ouyang,C.Xie,Y.P.Mao,et al.Significant efficacies of neoadjuvant and adjuvant chemotherapy for nasopharyngeal carcinoma by meta-analysis of published literature-based randomized,controlled trials[J].Annals of Oncology,2013,24(8):2136-2146.
[11]Jay S.Cooper,M.D.,Karen Fu,M.D.,James Marks,M.D.,et al.Late effects of radiation therapy in the head and neck region[J].International journal of radiation oncology,biology,physics,1995,31(5):1141-1164.
[12]Michael K.M.Kam,Sing-Fai Leung,Benny Zee,et al.Prospective randomized study of Intensity-Modulated radiotherapy on salivary gland function in Early-Stage nasopharyngeal carcinoma patients[J].Journal of Clinical Oncology,2007,25(31):4873-4879.
[2]赵充,韩非,卢丽霞,等.调强适形放射治疗对局部晚期鼻咽癌的临床疗效[J].癌症,2004,23(z1):1532-1537.
[3]Kam Michael K M,Teo Peter M L,Chau Ricky M C,et al.Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy:the Hong Kong experience[J].International journal of radiation oncology,biology,physics,2004,60(5):1440-1450.
[4]舒禹先,敖帆,吴志瑛,等.鼻咽癌调强放射治疗联合化疗的初步临床分析[J].实用癌症杂志,2014,29(08):946-950.
[5]黄生富,朱向帜,许建华,等.116例鼻咽癌一体化照射野调强放疗的疗效分析[J].临床肿瘤学杂志,2010,15(10):895-899.
[6]胡福军,陈晓钟,姜锋,等.局部晚期鼻咽癌调强放疗联合化疗135例临床分析[J].中华肿瘤防治杂志,2012,19(12):917-920.
[7]韩露,林少俊,潘建基,等.305例鼻咽癌调强放疗预后因素分析[J].癌症,2010,29(2):153-158.
[8]Shaojun Lin,Jiade Jay Lu,Lu Han,et al.Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma:Experience of 370 consecutive cases[J].BMC cancer,2010,10(1):39-
[9]J A Langendijk,C R Leemans,J Buter,et al.The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma:a meta-analysis of the published literature.[J].Journal of clinical oncology,2004,22(22):4604-4612.
[10]P.Y.Ouyang,C.Xie,Y.P.Mao,et al.Significant efficacies of neoadjuvant and adjuvant chemotherapy for nasopharyngeal carcinoma by meta-analysis of published literature-based randomized,controlled trials[J].Annals of Oncology,2013,24(8):2136-2146.
[11]Jay S.Cooper,M.D.,Karen Fu,M.D.,James Marks,M.D.,et al.Late effects of radiation therapy in the head and neck region[J].International journal of radiation oncology,biology,physics,1995,31(5):1141-1164.
[12]Michael K.M.Kam,Sing-Fai Leung,Benny Zee,et al.Prospective randomized study of Intensity-Modulated radiotherapy on salivary gland function in Early-Stage nasopharyngeal carcinoma patients[J].Journal of Clinical Oncology,2007,25(31):4873-4879.