鼻咽癌同期调强放化疗的临床研究

目的研究鼻咽癌同期调强放化疗的优化方案及其不良反应。方法2006年1月至2008年5月,35例Ⅱ～Ⅳa期鼻咽癌患者分成同期放化疗加辅助化疗组和同期增敏放化疗加辅助化疗组进行前瞻性研究。同期化疗采用DDP40mgd1～3＋5-Fu1.0d1～4,4周为1个周期;同期增敏化疗DDP30mgqw,放疗后辅助化疗DDP40mgd1、8、15＋紫杉醇90mgd1、8、15,休息1周继续。均行调强放疗,PGTV和CTV的中位剂量分别是70.6Gy和61.6Gy。临床检查结合CT用于近期疗效评价。CTC3.0评分标准评价急性副反应。结果全部患者随访期4～32个月,中位随访期是18个月,随访率100%。局部控制率98.2%。患者出现的口干、胃肠道反应、皮肤反应、骨髓抑制和体重下降均不影响治疗完成。急性口腔黏膜反应是化疗不能按计划进行的主要原因。放疗结束时14例完全缓解（CR）,同期放化疗和同期增敏放化疗各有8例和6例;21例部分缓解（PR）,同期放化疗和同期增敏放化疗各有17例和4例。结论急性口腔黏膜反应是限制同期调强放化疗按计划进行的主要因素。不含5-Fu的同期增敏化疗加辅助化疗的方案更能被患者接受,有可能取得更好效果。

Clinical study of concurrent chemotherapy and intensity modulated radiotherapy for nasopharyngeal carcinoma

Objective To evaluate adverse events of concurrent intensity modulated radiotherapy（IMRT） in patients with nasopharyngeal carcinoma,and the most optimized therapy for the disease.Methods Between January 2006 and May 2008,a prospective trial was performed in 35 patients with nasopharyngeal carcinoma（Ⅱ～Ⅳa stage） which were separated into concurrent radio-chemotherapy plus adjuvant chemotherapy group and concurrent sensitive radio-chemotherapy plus adjuvant chemotherapy group.Patients in concurrent radio-chemotherapy group received DDP 40mg d1～3 intravenous injection ＋ 5-Fu 1.0 d1～4 intravenous injection for continuous 96h and every 4 week was one cycle.Patients in concurrent sensitive radio-chemother-apy group received DDP 30 mg qw intravenous injection.Followed radiotherapy was adjuvant chemotherapy：DDP 40mg qw in-travenous injection ＋ Paclitaxel 90mg qw intravenous injection.3 weeks continuous treatment and 1 week rest was one cycle.All groups adopted intensity modulated radiotherapy（IMRT）.The median total dose of PGTV 和 CTV was 70.6Gy and 61.6Gy respectively.CT combining with clinical health examination was used to evaluate the therapy efficiency.CTC3.0 was adopted to evaluate acute adverse events.Results All the patients were followed-up for 4～32 months,mid-term follow-up period was 18 months.Follow-up rate was 100% and local control rate was 98.2%.Dry mouth,gastrointestinal reaction,skin reaction,bone marrow inhibition and weight loss found in the patients but didn＇t affect completion of therapy.While acute oral mucosa reac-tion stopped the chemotherapy being carried out as planned.When radiotherapy was finished,14 patients reached complete re-mission（CR）,8 in concurrent radio-chemotherapy group and 6 in concurrent sensitive radio-chemotherapy group.21 patients reached partial remission（PR）,17 in concurrent radio-chemotherapy group and 4 in concurrent sensitive radio-chemotherapy group.Conclusion Acute oral mucosa reaction is the main factor to stop concurrent IMRT bei