同期放化疗治疗鼻咽癌肿瘤残留与预后的关系

目的探讨同期放化疗治疗鼻咽癌肿瘤残留与预后的关系。方法80例鼻咽癌患者随机分为两组:单纯常规放疗组(A组)42例。常规放疗+同期化疗(B组)38例。原发灶和阳性淋巴结区DT70～76Gy/35～38次,7～8周,预防区DT50～60Gy/25～30次,5～6周。化疗方案为顺铂(DDP)20mg/m2静脉滴注,d1～5,5-氟尿嘧啶(5-FU)750mg/m2静脉滴注,d1～5,每3周1个疗程,共2个疗程,并分析鼻咽部及颈部肿瘤残留情况。结果3年无瘤生存率(DFS)A组45.23%(19/42)、B组71.1%(27/38),二者差异有统计学意义(χ2=5.47,P<0.05);3年总生存率(OS)A组57.1%(24/42),B组73.6%(28/38),二者差异无统计学意义(χ2=2.38,P>0.05);鼻咽癌放射治疗后有残留者较无残留者的1、3、5年生存率低;颈部残留灶越大,生存率越低;有残留者的局部复发率增高。结论鼻咽癌放射治疗后有残留者的生存率下降,放射治疗后肿瘤残留可作为判断预后的一个指标。

Radiotherapy and Chemotherapy Treatment of Nasopharyngeal Carcinoma in the same Period of Residual Tumor and Prognosis

Objective Discussion on the treatment of nasopharyngeal cancer radiotherapy and chemotherapy in the same period of residual tumor and prognosis. Methods 80 patients of stageⅢ~Ⅳ a nasopharyngeal carcinoma were randomized into radiotherapy alone group (A group, 42 patients) and radiotherapy +chemotherapy group (B group, 38 patients). The dose at the primary lesion and metastastic lymph node were usually DT 70~76 Gy/35~38 fractionation in 7~8 weeks. DT 50~60 Gywas used prophylactically for the neck region which had been from metastasis.Before radical radio therapy patients of B group received cisplatin 20mg/m2, d1~5, 5-fluorouracil 750mg/m2, d1~5, every three weeks as one cycle to totally 2 cycles. Results The 3-year disease-free survival rates (DFS) were 47. 8% (22/46) in A group,71.7% (33/46) in B group respectively. Two groups had difference (p>0.05); The overall 1, 3, 5 year survival rates (OS) signifi cantly decreased in the residual group. The overall survival rate was highest in the group with nasopharynx residual alone, and the lowest in nasopharynx plus residual lymph node group. The bigger the residual lesion, the lower the overall survival rate. Conclusions The overall survival rate decreases in patients with residual lesion after radiotherapy, Tumor residual after radiotherapy can be a prognostic indicator for patients with NPC.