鼻咽癌外照射联合腔内后装治疗分析

[目的]分析Ⅱ、Ⅲ期鼻咽癌外照射联合高剂量率腔内后装治疗的生存率，局部控制率。[方法]1993年10月至1994年10月收治的Ⅱ、Ⅲ期鼻咽癌148例，外照射加腔内后装治疗（综合组）74例，单纯外照射（对照组）74例，分组比较两组的5年局部控制率，将综合组的Ⅱ，Ⅲ期与对照组的Ⅱ、Ⅲ期分别进行1，3，5年生存率比较。并将Ⅱ期病人T／N分期进行3年生存率比较。[结果]综合组在5年局部控制率为81．1％，对照组为62．2％，差异有显著性（P＜0．001）。Ⅱ期鼻咽癌中综合组的5年生存率为76．9％，对照组为57．6％（P＜0．05），Ⅱ期中的T1鼻咽现人的5年生存率，综合组比对照组有明为提高，且统计学有意义。Ⅲ期鼻咽癌中，综合组的1，3，5年生存率与对照组比较无统计学意义。[结论]外照射联合后装治疗对鼻咽癌病人的控制率有明显提高。对Ⅱ期病人中T1的5年生存率有重要意义,而对Ⅲ期病人，无论近期疗效或远期治疗与对照组比较均无明显差异。     

鼻咽癌常规分割与后程加速超分割放疗远期结果分析

目的 对比分析常规分割（CF）与后程加速超分割（LCAHF）放疗鼻咽癌的远期疗效，以探索更好的鼻咽癌放疗方案。方法 回顾性分析符合人组条件的鼻咽癌患者496例，其中cF组269例，LCAHF组227例。两组均采用双侧面颈联合野对穿照射，200cGy／次，5次／周，鼻咽部剂量达36～40Gy后改为双侧耳前野或小面颈野对穿避开脊髓继续照射；CF组继续用原分割方案照射至鼻咽部总剂量68—76Gy，LCAHF组改用150cGy／次，2次／d，两次间隔至少6h，总剂量达69～72Gv。采用Kaplan-Meier法进行生存分析。结果 LCAHF组及cF组5年鼻咽原发灶控制率、无瘤生存率、总生存率分别为65．4％、61．5％、68．1％和52．8％、49．4％、57．5％（P=0．006、0．006、0．031），而鼻咽部复发率明显低于cF组（P〈0．05）。进一步按T分期进行分析显示LCAHF主要提高了1、2、13期患者5年鼻咽原发灶控制率、无瘤生存率及总生存率（P〈0．05）。两组急性毒副反应及放射后遗症相似（P〉0．05）。颈部淋巴结复发率及远处转移率两组相似（P〉0．05）结论 与常规分割放疗相比，后程加速超分割放疗提高了鼻咽癌局部控制率、无瘤生存率及总生存率，降低了鼻咽部复发率，并能被鼻咽癌患者耐受，但未减少颈部淋巴结复发率及远处转移率。     

^60Co外照射加高剂量率腔内后装放射治疗鼻咽癌疗效分析

目的　分析 6 0 Co外照射加高剂量率腔内后装放疗治疗鼻咽癌的疗效 ,局部控制率及放射并发症。方法 :回顾性分析 1989年 5月～ 1996年 3月采用 6 0 Co外照射加高剂量率腔内后装放疗鼻咽癌 30例。结果　本组病例总的近期局部控制率为 73.33% (2 2 / 30 ) ,无瘤生存率为 6 0 %转移11例 ,无一例发生晚期放射并发症。结论　腔内后装放疗鼻咽癌 ,可提高局部控制率 ,适应于鼻咽癌早期及鼻咽癌外照射后鼻咽腔内残留病灶。     

鼻咽癌腔内近距离超分割推量照射的研究

目的 分析鼻咽癌腔内近距离超分割放射治疗的临床及效及适应证的选择。方法 体外照射＋腔内后装超分割推量放射治疗鼻咽癌128例，体外常规放射治疗50－66Gy后进行腔内近距离放射治疗，1996年6月以后由于经颌下鼻咽旁区插植术的开展，腔内后装的适应证的选择严格按肿瘤侵犯深度在鼻咽部粘膜下≤10mm。施源管技术采用个体化模块将施源管固定在鼻咽腔内，并将软腭推开，剂量分割采用超分割法2．5－3．0Gy／次，2次／d，间隔6h，总剂量12－24Gy，中位剂量18Gy。体外照射剂量分为3个组，即：56Gy组44例（其中37例为56Gy），60Gy组54例，66Gy组30例。结果 全组3、4年无瘤生存率分别为84．2％、74．9％，3、4年局部无复发生存率分别为97．1％、92．7％。体外照射56、60和66Gy组的3年无瘤生存率分别为83．6、88．4％和84．6％（X^6=0.92,P=0.63),3年局部无复发生存率分别为100％、90．9％、93．3％（X^2=0.25,P=0.88)，差异均无统计学意义。结论 腔内近距离治疗前应该进行CT或MRI影像评价并进行严格的适应证选择及后装技术的选择，腔内近距离治疗的适应证为病变厚度≤10mm的病例为好。在此基础上T1、T2期鼻咽癌计划外照射的剂量可以降低至56Gy。腔内近距离治疗超分割方法的晚期放射性反应少，患者可以耐受，具有可行性。     

T3～T4N0～N3期鼻咽癌单纯放疗疗效分析

目的 探讨不同T分期与N分期对局部晚期鼻咽癌单纯放疗疗效的影响。方法 回顾分析556例T3～T4N0～N3期（1992年福州分期）鼻咽癌初治患者临床资料。全组病例均采用面颈联合野照射技术给予单纯常规放疗。原发灶照射总剂量66～80Gy（6.5～8．0周完成），颈淋巴结转移灶照射总剂量60～70Gy（6～7周完成）。结果 全组病例5年总生存率为66．4％。T3期5年总生存率为69．1％，T4期的为59.0％（P〈0．05）；两者局部控制率、无瘤生存率、无复发生存率以及无转移生存率均无差别。N0、N1、N2、N3期的5年总生存率分别为74．0％、66．0％、57．6％、29．4％（P〈0．01），N分期越高复发率和远处转移率越高。结论 单纯常规放疗的局部晚期鼻咽癌患者中。N分期是影响疗效及预后的主要因素，T分期为次要因素。对不同N分期的局部晚期鼻咽癌患者进行分层放化疗，对于解决治疗失败的原因——复发与远处转移也许会起到积极和有效的作用。     

体外照射联合^252Cf中子后装治疗T1、T2期鼻咽癌的临床研究

目的比较单纯常规体外照射与体外照射联合^252Cf中子后装治疗T1、T2期鼻咽癌原发灶的局部控制疗效和并发症。方法对30例初治的T1期和部分T2期鼻咽癌病例进行体外照射联合^252Cf中子后装治疗。结果全部病例随访2年,鼻咽局部复发2例,2年局部控制率93．3％,远处转移4例,张口困难2例,无一例患者发生软腭穿孔。结论体外照射联合^252Cf中子后装治疗鼻咽癌,增加了鼻咽腔内照射剂量,提高了局部控制率,减少了鼻咽癌外照射剂量,有利于降低张口困难的发生率。     

超分割放疗联合化疗治疗局部晚期鼻咽癌的疗效观察

目的：观察超分割放疗同时化疗对局部晚期鼻咽癌近期、远期疗效的影响及毒性反应。方法：69例Ⅲ、Ⅳa期初治NPC患者随机分为超分割放疗＋化疗组；超分割放疗组；常规放疗组，鼻咽原发灶采用^40Co外照射．颈部淋巴结引流区采用^60Co前切线照射加深部X线垂直照射。结果：放疗结束后3个月时鼻咽原发灶消退率分别为80．0％、68．4％和55．0％，各组间无统计学差异（P〉0．05）；颈部淋巴结消退率分别为82．4％、52．9％和50.0％．其中化疗组明显高于常规放疗组（P〈0．05），其余各组间均无统计学差异（P〉0．05）。3年生存率（70．0％，73．7％，65．0％）。结论：超分割放疗同时联合化疗可提高近期颈部淋巴结的完全消退率，但未能提高长期生存率、改善局部控制率和减少远地转移率，其毒性反应可耐受。     

早期鼻咽癌单纯外照射与加近距离治疗的远期结果比较

目的随机比较单纯常规外照射与外照射加近距离治疗对早期鼻咽癌原发灶的局部控制疗效和并发症。方法对126例初治的、福州分期为T1期和部分12期(口咽、颈动脉鞘、椎前软组织受侵者除外)鼻咽癌病例进行前瞻性分组。单纯常规外照射组(RT)61例，外照射加^192Ir高剂量率近距离治疗组(RB)65例。26例T1期在疗前经抽签随机接受单纯外照射66～70Gv或外照射56Gv加近距离治疗10～16Gy，1～2次(中位剂量16Gy)；100例12期先采用常规外照射至50Gy后，行CT或MRI检查，对咽旁间隙消退满意的病例入组随机接受单纯外照射(中位剂量72Gv)或外照射(中位剂量66Gy)加近距离治疗8～24Gy，1～3次(中位剂量16Gy)。近距离治疗在外照射结束后1周进行，剂量参考点距施源器中心轴的距离为7～12mm，单次近距离照射剂量为5～8Gy／周。结果外照射结束时RT组鼻咽病灶残留6例，消退55例；RB组残留13例，?肖退46例，未评价6例。RT组鼻咽部失败8例，RB组鼻咽部失败7例(包括单独颅底失败2例)。5年鼻咽(颅底)局部控制率RT组为86％，RB组为88％。5年总生存率RT组为83％，RB组为84％(P=0．84)。放射性脑病RT组为10例(1级4例，2级6例)，RB组为7例(1级4例，2级3例)。张口困难发生率RT组明显高于RB组(26％：10％，P=0．02)。结论对早期鼻咽癌行计划性外照射加腔内近距离治疗，能获得与单纯常规外照射相近的局部控制率及总生存率，并降低外照射剂量和减低张口困难的发生率。     

鼻咽癌外照射及近距离治疗的前瞻性随机分组研究

目的 比较计划性外照射加腔内近距离治疗和单纯外照射对早期鼻咽癌的5年局部控制率、5年生存率以及后遗症。材料与方法 自1990年3月至1996年11月，对124例T1、T2初治的鼻咽癌患者进行了前瞻性随机分组研究。男性86例，女性38例，中位年龄47岁，全部病例均经病理证实，除1例为腺鳞癌外，余均为低分化癌鳞外，余均为低分化鳞癌，Karnofsky评分均≥80分，中位随诊期；62个月（5-84个月），全组外照射采用6-8MV-X线，腔内近距离治疗采用高剂量率^192Ir微源，随机分组方法；全部病例先采用常规外照射采用6-8MV-X线，腔内近距离治疗采用剂量率^192Ir微源，随机分组方法：全部病例行采用常规外照射技术（面颈联合野加耳前野），CT或MRI提示咽旁间隙未受侵者外照射剂量予DT50-60Gy，咽旁间隙受侵者予DT50-70Gy，然后行鼻咽CT或MRI检查，对于咽旁间隙肿瘤消退满意的病例，采用信封法分为单纯外照射组（RT）60例和计划性外照射加腔内近距离治疗组（RB）64例，RT组则继续外照射至根治剂量，70-86Gy(中位剂量75Gy)。RB组则在休息1周后采用腔内近距离治疗加量，每周治疗1次，除7例因在外照射至鼻咽DT40-55Gy时肿瘤已完全消失的患者仅行1次腔内治疗外，余57例均接受了2-3次腔内近距离治疗，剂量参考点距施源器中心轴的距离是7-12mm，参考点剂量为每次6-8Gy(中位剂量8Gy)。近距离治疗的总剂量为8-22Gy(中位剂量16Gy)，1-3周。5年生存率和局部控制率的评价采用Kaplan-Meier法，两者之间的差异比较采用Log rank法进行检验。结果 124例中单纯外照射组有2例治疗失败，疗终（鼻咽DT72Gy和70Gy)局部肿瘤残存，并进行腔内近距离治疗营救，目前无瘤生存已3.5年和4年。8例（RT6例，RB2例）出现局部复发（其中4例死亡），中位复发时间为12个月。124例鼻咽癌RT和RB两组的5年局部控制率分别为85.2%和93.9%，5年生存率分别为85.2%和88.0%,经Log rank法检验两者之间的差异无统计学意义（P>0.05)。124例中9例出现远地转移，其中肝转移6例（1例同时伴有肺、骨和淋巴结转移），肺转移1例，骨转移1例（同时伴有腋窝淋巴转移），1例脑转移（脑脊液中找到癌细胞）。颈部复发1例并经手术补救。结论 本组前瞻性随机分组研究结果表明，单纯外照射或外照射加腔内近距离治疗早期鼻咽癌，后者的5年局部控制率较前者略高，虽经统计学处理两者之间无差异。但至少证明计划性外照射加腔内近距离治疗在降低外照射剂量的同时，不降低局部控制率及生存率，并且在恰当的近距离治疗技术条件下，未观察到软腭穿孔、蝶骨体坏死等严重并发症。     

80例鼻咽癌应用新型施源器腔内后装治疗的疗效分析

目的：探讨鼻咽癌外照射联合新型施源器后装治疗与单纯外照射的疗效和并发症方法：将80例初治鼻咽癌患者按治疗方法分为外照射联合腔内后装（综合治疗组）及单纯外照射（对照组）两组，综合治疗组外照射剂量DT60～65Gy，腔内后装在外照射后期进行，剂量DT6～20Gy，中位剂量12Gy对照组外照射剂量DT 70～75Gy.结果：全部病例随访至2006年5月，随访率97．5％，综合治疗组和对照组的近期有效率分别为92．5％、75．3％（P〈0．05），3、5年生存率分别为87．5％、65．0％（P〈0．05）及74．2％、55．6%（P〉0．05）;3、5年无瘤生存率分别为72．5％、60．0％及64．5％、52．8％（P〉0．05），两组并发症发生率有显著性差异.结论：鼻咽癌外照射联合新型施源器后装治疗提高肿瘤近期有效率和3、5年生存率，降低口咽干燥等放疗并发症发生，提高生活质量.     

鼻咽癌低氧放疗的临床观察

背景与目的:近年来国内肿瘤低氧放疗的临床应用开展很快。低氧对正常组织放射保护作用已被证实,但它是否对肿瘤也存在保护作用尚无肯定答案。本研究比较鼻咽癌患者常规放疗和低氧放疗的临床结果,并加以分析。方法:收集1992年3月至2000年6月间在我院接受低氧放疗或常规放疗的117例鼻咽癌病例。其中Ⅰ期11例、Ⅱ期30例、Ⅲ期57例、Ⅳ期19例。低氧组69例接受低氧放疗,常规组48例接受常规放疗。两组患者年龄、性别、TNM分期、病理分类、辅助治疗等均无显著性差异(P>0.05)。全部病例均应用6MVX线和8～12MeV电子线照射,鼻咽部剂量72Gy(68～82Gy),颈部转移淋巴结剂量64Gy(60～70Gy)。结果:2～3级急性口咽粘膜、唾液腺损伤和2～3级晚期口干症在低氧组的发生率分别为23.2%、26.1%和37.7%,在常规组分别为77.1%、62.5%和91.7%(P≤0.01)。肿瘤局部复发、颈淋巴结复发转移和远处转移率在低氧组分别为14.5%、23.2%和21.7%,常规组分别为12.5%、20.8%和18.8%(P>0.05)。低氧组1、3、5、7年生存率分别为97.1%、83.7%、74.4%和54.5%,常规组分别为97.9%、86.8%、70.2%、54.7%(P>0.05)。结论:低氧能减轻放射治疗引起的不良反应,降低并发症发生率;初步观察低氧放疗后肿瘤复发、转移及患者生存情况与常规放疗无明显差异,但仍需     

Locally recurrent nasopharyngeal carcinoma.

PURPOSE: To assess the outcome of and determine prognostic factors for locally recurrent nasopharyngeal carcinoma (NPC) in patients treated with a second course of radiotherapy (RT). MATERIALS AND METHODS: From 1982 to 1995, 186 NPC patients, who had initially been treated in the Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou, developed local recurrence in the nasopharynx and were re-treated with RT (>/=20 Gy). The time from the initial RT to re-treatment ranged from 8 to 136 months (median: 23 months). All patients were treated with external RT and conformal radiotherapy was used in 35 patients after 1993. Fifteen received radiosurgery as a boost treatment. The RT dose at the nasopharyngeal tumor area ranged from 20 to 67.2 Gy (median 50 Gy). Eighty-two patients received one to eight courses of cisplatin-based chemotherapy in addition to RT. RESULTS: The 1-, 3- and 5-year survival was 54.9, 22. 1 and 12.4%, respectively. Patients whose tumor relapsed later than 2 years after the first treatment had a better survival than those with earlier relapse (3-year survival: 30.1 vs. 10.8%; P=0.015), but the difference became insignificant in patients who received >/=50 Gy. Patients without evidence of intracranial invasion or cranial nerve palsy had better survival than those with such lesions (3-year survival: 30.9 vs. 3.7%; P=0.006). A re-treatment dose >/=50 Gy yielded better survival (3-year survival: 22.8 vs. 18.5%; P=0.003). Addition use of radiosurgery may improve survival. The use of chemotherapy did not improve survival. Conformal radiotherapy resulted in significantly fewer severe complications than conventional RT. CONCLUSIONS: A repeat course of RT for locally recurrent NPC successfully prolongs survival in a significant number of patients. Intracranial invasion and/or cranial nerve palsy and re-treatment dose affect the prognosis, with a dose of >/=50 Gy significantly improving survival. Radiosurgery boost may also improve survival. Our preliminary data indicates that conformal radiotherapy may decrease the severity of radiation-induced complications. However; longer follow-up and larger sample size is necessary to document the findings.     

Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety.

PURPOSE: The Intergroup 00-99 Trial for nasopharyngeal cancer (NPC) showed a benefit of adding chemotherapy to radiotherapy. However, there were controversies regarding the applicability of the results to patients in endemic regions. This study aims to confirm the findings of the 00-99 Trial and its applicability to patients with endemic NPC. PATIENTS AND METHODS: Between September 1997 and May 2003, 221 patients were randomly assigned to receive radiotherapy (RT) alone (n = 110) or chemoradiotherapy (CRT; n = 111). Patients in both arms received 70 Gy in 7 weeks using standard RT portals and techniques. Patients on CRT received concurrent cisplatin (25 mg/m2 on days 1 to 4) on weeks 1, 4, and 7 of RT and adjuvant cisplatin (20 mg/m2 on days 1 to 4) and fluorouracil (1,000 mg/m2 on days 1 to 4) every 4 weeks (weeks 11, 15, and 19) for three cycles after completion of RT. All patients were analyzed by intent-to-treat analysis. The median follow-up time was 3.2 years. RESULTS: Distant metastasis occurred in 38 patients on RT alone and 18 patients on CRT. The difference in 2-year cumulative incidence was 17% (95% CI, 14% to 20%; P = .0029). The hazard ratio (HR) for disease-free survival was 0.57 (95% CI, 0.38 to 0.87; P = .0093). The 2- and 3-year overall survival (OS) rates were 78% and 85% and 65% and 80% for RT alone and CRT, respectively. The HR for OS was 0.51 (95% CI, 0.31 to 0.81; P = .0061). CONCLUSION: This report confirms the findings of the Intergroup 00-99 Trial and demonstrates its applicability to endemic NPC. This study also confirms that chemotherapy improves the distant metastasis control rate in NPC.     

Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of china

PURPOSE: A prospective randomized trial was performed to evaluate the efficacy of concurrent chemotherapy and adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) in endemic regions of China. METHODS AND MATERIALS: Between July 2002 and September 2005, 316 eligible patients were randomly assigned to receive either radiotherapy alone (RT) or chemoradiotherapy concurrent with adjuvant chemotherapy (CRT). All patients received 70 Gy in 7 weeks using standard RT portals and techniques. The CRT patients were given concurrent cisplatin (40 mg/m(2) on Day 1) weekly during RT, followed by cisplatin (80 mg/m(2) on Day 1) and fluorouracil (800 mg/m(2) on Days 1-5) every 4 weeks (Weeks 5, 9, and 13) for three cycles after completion of RT. All patients were analyzed by intent-to-treat analysis. RESULTS: The two groups were well-balanced in all prognostic factors and RT parameters. The CRT group experienced significantly more acute toxicity (62.6% vs. 32%, p = 0.000). A total of 107 patients (68%) and 97 patients (61%) completed all cycles of concurrent chemotherapy and adjuvant chemotherapy, with a median follow-up time of 29 months. The 2-year overall survival rate, failure-free survival rate, distant failure-free survival rate, and locoregional failure-free survival rate for the CRT and RT groups were 89.8% vs. 79.7% (p = 0.003), 84.6% vs. 72.5% (p = 0.001), 86.5% vs. 78.7% (p = 0.024), and 98.0% vs. 91.9% (p = 0.007), respectively. CONCLUSIONS: This trial demonstrated the significant survival benefits of concurrent chemotherapy plus adjuvant chemotherapy in patients with locoregionally advanced NPC in endemic regions of China.     

Hyperfractionated radiation therapy for locoregionally advanced nasopharyngeal cancer

OBJECTIVE: The purpose of this study is to clarify the efficacy and toxicity of hyperfractionated radiation therapy (RT) for patients with nasopharyngeal cancer (NPC). METHODS: Twenty-two patients with NPC treated at our hospital between April 1994 and December 2002 were the subjects of this study. They received hyperfractionated RT with a fraction size of 1.2 Gy, with a median tumor dose of 72 Gy (range 64.8-80.4). During this study period, our institutional strategy for locoregionally advanced NPC included neoadjuvant or concurrent chemotherapy combined with hyperfractionated RT, and 17 patients received some forms of cisplatin-containing chemotherapy. RESULTS: With a median follow-up of 59 months, the estimated 5-year disease-free survival rate and overall survival rate were 72.7 and 85.2%, respectively. Acute hematological toxicities were acceptable and manageable. However, >50% of patients required nutritional support, and experienced severe pharyngitis, skin reaction and body weight loss. With regard to late sequelae, one patient developed grade 3 osteomyelitis, and one patient each developed grade 4 passage disturbance and laryngeal edema. No patients experienced any grades of optic nerve injury or temporal lobe necrosis. CONCLUSIONS: Hyperfractionated RT using 1.2 Gy per fraction, for a total dose of 72 Gy, produces a comparable treatment outcome. Although deleterious neurological sequelae were not observed in this study, caution should be exercised regarding other late sequelae, such as osteomyelitis and passage disturbance.     

A phase III study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients

To evaluate the role of adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma (NPC) patients, we conducted a randomized Phase III trial comparing radiotherapy (RT) followed by adjuvant chemotherapy to RT alone in patients with advanced NPC.

Between November 1994 and March 1999, 157 patients with Stage IV, M₀ (UICC/AJCC, 1992) advanced NPC disease were randomized to receive standard radiotherapy, as follows: 35–40 fractions, 1.8–2.0 Gy/fraction/day, 5 days/week, to a total dose 70–72 Gy with or without 9 weekly cycles of 24-h infusional chemotherapy (20 mg/m² cisplatin, 2,200 mg/m² 5-fluorouracil, and 120 mg/m² leucovorin) after RT. Of 157 patients enrolled, 154 (77 radiotherapy, 77 combined therapy) were evaluable for survival and toxicity analysis.

With a median follow-up of 49.5 months, the 5-year overall survival and relapse-free survival rates were 60.5% vs. 54.5% (p = 0.5) and 49.5% vs. 54.4% (p = 0.38) for the radiotherapy-alone group and the combined radiotherapy and adjuvant chemotherapy group, respectively. The Cox regression showed that the hazard rates ratio of combined treatment to RT alone was 0.673 (p VALUE = 0.232); the 95% confidence interval was 0.352 and 1.288, respectively. Patients who received combined treatment had a lower systemic relapse rate than radiotherapy-alone patients, according to relapse pattern analysis. The incidence of leukopenia (≥ Grade 3) occurred in 17 out of 819 (2.1%) cycles of weekly chemotherapy. No patient developed moderate to severe mucositis (≥ Grade 3).

We conclude that adjuvant chemotherapy after RT for patients with advanced NPC has no benefit for overall survival or relapse-free survival.     

Intracavity hyperthermia in nasopharyngeal cancer: A phase III clinical study

Purpose: To compare the local tumour control, survival, and acute mucous toxicity of nasopharyngeal cancer (NPC) patients treated with conventional radiotherapy (RT) combined with intracavity hyperthermia versus conventional RT alone.

Methods and materials: Previously untreated NPC patients were assigned randomly into the conventional RT group and the hyperthermia group. In addition to curative RT, hyperthermia group patients received intracavity hyperthermia before or after RT; T90 was 42.5°–43°C for 50 min twice a week for 7 weeks.

Results: From August 2001 to July 2006, 180 eligible patients with NPC were enrolled in this study. The complete response (CR) rate in the two arms (RT plus hyperthermia versus conventional RT) was 95.6% and 81.1%, respectively (p = 0.003, χ² test). CR rates for T2 and T3 patients in the hyperthermia group were 97.1% and 96.9%, respectively, while in the conventional RT group they were 79.5% and 76.7%, respectively. The difference between the two groups was statistically significant (p = 0.03 and p = 0.024, respectively). The 5-year local control rate was 91.1% and 78.9% for the two arms, respectively (p = 0.022). Oral mucous toxicity in both arms was comparable. The 5-year PFS and 5-year OS rate for the hyperthermia arm vs. the conventional arm were 72.7% versus 63.1% (p = 0.039) and 78.2% versus 70.3% (p = 0.14), respectively.

Conclusions: Conventional RT treatment followed by intracavity hyperthermia was well tolerated by the NPC patients. The addition of hyperthermia improved the local tumour control, and our results indicated a positive impact on PFS of NPC patients.     

奈达铂每周方案同期适形放疗治疗局部晚期鼻咽癌的临床研究

目的:探讨周剂量奈达铂化疗同步适形放疗治疗局部晚期鼻咽癌的疗效及不良反应。方法:81例局部晚期鼻咽癌患者,随机分为奈达铂同期适形放疗组(CRT组)和单纯适形放疗组(RT组)。RT组患者仅行适形放疗,CRT组患者在适形放疗的基础上加用奈达铂。观察两组患者的近期疗效、远期疗效和不良反应。结果:鼻咽部肿块残存率:CRT组为12.2%(5/41),RT组为20.0%(8/40);颈部肿块残存率:CRT组为17.1%(7/41),RT组为37.5%(15/40),CRT组明显低于RT组(P<0.05);CRT组和RT组1、3年生存率分别为92.7%(38/41)、75.6%(31/41)和92.5%(37/40)、70.0%(28/40)(P>0.05)。不良反应主要表现为白细胞减少和Ⅲ度口腔黏膜反应。结论:小剂量奈达铂每周化疗同步放疗可提高局部晚期鼻咽癌颈淋巴消除率,其不良反应可接受。     

Patterns of failure following radiation with and without chemotherapy in patients with nasopharyngeal carcinoma

PURPOSE: Aim of this study was to retrospectively evaluate patterns of failure, results, and prognostic factors for patients with nasopharyngeal cancer (NPC) following radiotherapy (RT) with and without concurrent chemotherapy (RCT). PATIENTS AND METHODS: Between 1978 and 1999, a total of 101 patients with NPC were treated in our hospital, of whom 53 received external megavoltage RT alone with a median total dose of 76 Gy (1978-1988), and 48 patients had RCT (1989-1999). For RCT a combination of 5-FU and cisplatin was used together with a median total dose of 72 Gy. Patterns of relapse, survival rates and toxicity as well as prognostic factors were evaluated retrospectively. RESULTS: RCT was associated with a marked reduction in distant metastases: 6/48 (13%) vs. 17/53 (32%) after RT alone. Locoregional tumor persistence was only marginally lower with RCT: 10/48 (21%) vs. 17/53 (32%) following RT. Patients with RCT demonstrated a survival advantage compared to those with RT alone (5-year overall survival (OS): 64% vs. 44%, p = 0.1). OS, disease-specific survival and locoregional control rates were 53, 57, and 78% at 5 years and 47, 51 and 78% at 10 years, respectively. OS was significantly affected by histology (p = 0.007), the patients' age (p = 0.009) and gender (p = 0.01). CONCLUSION: This retrospective study provides further evidence that both reduction of distant metastasis and enhanced local tumor control by combined radiochemotherapy may be associated with improved survival rates in NPC compared to radiation alone. Concurrent RCT is therefore considered the preferable treatment option, however, confirmation in randomized trials is still warranted.     

安卡合并放射治疗鼻咽癌5年随访观察

目的:马蔺子素(安卡胶囊)是从中草药马蔺子(Irisquinones)的种皮中所提取出来的一种醌类化合物,为观察安卡合并放射治疗鼻咽癌的增敏疗效进行本次观察.方法:1995年3月～1996年3月在广州中山医科大学附属肿瘤医院,将病理证实为鼻咽癌Ⅰ～Ⅳa期(92福州分期)的患者104例,随机分为单纯放疗组(简称单放组)52例和马蔺子素与放射联合治疗组(简称药放组)52例进行临床观察.采用Co60治疗机、能量为1.25MeV的γ射线连续照射,常规放疗.结果:5年生存随访结果提示:单放组5年生存率66%,药放组5年生存率67%,药放组生存率高于单放组,但是无统计学差异(P＞0.05);同时还比较了两组患者在张口困难、听力下降、脑脊髓病等远期反应的发生率,无统计学差别.通过生存统计(Cox)模型,筛选出影响生存的主要因素是患者分期的早晚和是否出现放疗失败.结论:安卡配合放射治疗鼻咽癌能否提高远期疗效,仍需追踪观察和扩大病例、以及增加病种试验.