局部晚期鼻咽癌诱导化疗后调强放疗同期化疗疗效评价

目的 评价NP方案诱导化疗后调强放疗同期化疗对局部晚期鼻咽癌的疗效和不良反应。
方法 2005-2009年62例经病理、细胞学证实的局部晚期鼻咽癌患者入组,先长春瑞滨(25 mg/m²)和顺铂(25 mg/m²)诱导化疗 2~4周期,然后调强放疗同期化疗。常规分割放疗,鼻咽部 72~76 Gy分 36~38次(有局部残留则γ刀加量5 Gy),颈部淋巴结区预防照射50 Gy (肿大淋巴结则加量至 60~70 Gy)。
结果 随访率为100%。鼻咽原发灶有效率为89%,颈部淋巴结有效率为90%。1、2、3年总生存率,无瘤生存率,无局部区域复发生存率和无远处转移生存率分别为97%、92%、82%,94%、73%、65%,97%、89%、87%和97%、84%、77%。3~4级急性反应发生率白细胞减少为37%、血小板减少为18%、黏膜炎为6%。无 3~4级远期颞颌关节损伤及口干症状。
结论 局部晚期鼻咽癌采用25 mg/m²长春瑞滨、顺铂诱导化疗后调强放疗同期化疗的生存率较高,不良反应可耐受。

Therapeutic effect of concurrent chemotherapy and intensity-modulated radiotherapy following induction chemotherapy in patients with locally advanced nasopharyngeal carcinoma

Objective To investigate the therapeutic effect and side effects of concurrent chemotherapy and intensity-modulated radiotherapy (IMRT) following induction chemotherapy (IC) in patients with locally advanced nasopharyngeal carcinoma (NPC).
Methods From January 2005 to January 2009, 62 cases of locally advanced NPC confirmed by pathological and cytological examination received IC with vinorelbine (25 mg/m²) plus cisplatin (25 mg/m²) for 2—4 cycles and then concurrent chemotherapy and IMRT. Conventional fractionated radiotherapy was adopted in IMRT. The radiotherapy for the nasopharyngeal region was performed a dose of 72—76 Gy/36—38 fractions, and additional 5-Gy gamma-knife treatment was carried out in case of local tumor residue. Prophylactic irradiation to the cervical lymph nodes was performed at a dose of 50 Gy, and the dose was increased to 60—70 Gy in case of lymph node enlargement.
Results The follow-up rate was 100%. The patients showed a response rate (RR) of 89% in the nasopharyngeal region and an RR of 90% in the cervical lymph nodes. The 1-, 2-, and 3-year overall survival rates, disease-free survival rates, local relapse-free survival rates, and distant metastasis-free survival rates were 97%, 92%, and 82%, 94%, 73%, and 65%, 97%, 89%, and 87%, and 97%, 84%, and 77%, respectively. The incidence rates of grade 3—4 acute reactions were 37% for leucopenia, 18% for thrombocytopenia, and 6% for mucositis. No grade 3—4 long-term temporomandibular joint injury and xerostomia were observed.
Conclusions Concurrent chemotherapy and IMRT following IC with vinorelbine (25 mg/m²) plus cisplatin (25 mg/m²) have tolerable adverse effects and can achieve high survival rate in the patients with locally advanced NPC.