早期全程营养干预与局部晚期鼻咽癌患者生存预后的关系分析

目的:通过观察早期全程营养干预对行同步放化疗治疗的局部晚期鼻咽癌患者预后的影响,证实早期全程营养干预措施对改善同步放化疗患者预后有重要意义。方法:收集2000年12月1日至2013年12月30日我院肿瘤防治中心884例初治局部晚期鼻咽癌患者的临床资料,全部患者均接受同步放化疗,按接受营养支持方式将患者分为早期全程营养干预组（NI组）和普通治疗组（UC组）,记录并分析患者5年总生存（OS）、疾病特异性生存(DSS)、无局部复发生存（LRFS）和无远处转移生存（DMFS）相关数据变化。结果:884例患者治疗后,早期全程营养干预组（NI组）OS、DSS、LRFS及DMFS均较普通治疗组（UC组）改善,差异有统计学意义（P<0.05）,亚组分析,营养干预后体重稳定组OS、DSS均高于体重下降组及普通治疗组（P<0.05）。结论:早期全程营养干预对改善局部晚期鼻咽癌患者预后具有重要意义,应作为局部晚期鼻咽癌综合治疗中的重要组成部分。     

早期全程营养干预对局部晚期鼻咽癌患者同步放化疗的影响

目的:观察早期全程营养干预对局部晚期鼻咽癌患者同步放化疗治疗期间营养指标变化及放化疗毒副反应的影响。方法:采用前瞻性、随机对照的方法,以2015年1月1日至2016年7月30日在我院肿瘤防治中心行同期放化疗治疗的46例鼻咽癌患者作为研究对象。按接受营养支持方式将患者分为早期全程营养干预组(NI组)和普通护理组(UC组),观察营养状况相关指标的变化及放疗后出现口腔黏膜炎及张口困难的发生率,分析营养干预对营养指标变化及放化疗黏膜反应发生率的影响。结果:46例患者全部按照计划完成治疗。治疗后两组患者体质指数(BMI)、血红蛋白(Hb)、白蛋白(ALB)水平均有下降,NI组患者较UC组患者下降幅度小,差异有统计学意义(P<0.05)。PG-SGA营养评估的评分值,NI组均低于UC组(P<0.05);QOL评分,NI组均好于UC组(P<0.05);同步放化疗后两组患者均发生不同程度毒副反应,其中NI组吞咽困难(P=0.022)、口腔黏膜炎(P=0.038)及需要使用止痛药(P=0.047)的发生率均较UC组下降,差异有统计学意义。结论:鼻咽癌患者同步放化疗期间营养状况均有下降,早期全程营养干预可减弱营养状况的下降及降低毒副反应发生率,对于完成治疗保证疗效具有重要意义。早期全程营养干预应作为局部晚期鼻咽癌综合治疗中的重要组成部分。     

局部晚期鼻咽癌同期放化疗患者营养状况与生活质量的相关性研究

目的分析局部晚期鼻咽癌患者治疗期间营养状况,探讨营养状况与生活质量的相关性。方法采用调查问卷对136例局部晚期鼻咽癌同期放化疗患者分别在治疗前及治疗第14天、第28天、第42天、第56天、治疗后3、6个月进行营养状况、生活质量评价,并分析营养状况与生活质量之间的相关性。结果患者在治疗期间均发生不同程度的营养不良,且持续到治疗结束后6个月。多因素分析显示,患者的总体健康状况、认知功能、止痛药物、情绪功能、疲劳、腹泻、口干、唾液黏稠、食欲丧失和失眠等因素与营养状况密切相关（P〈0．01）。结论局部晚期鼻咽癌同期放化疗患者治疗期间普遍存在不同程度的营养不良,并与生活质量中的多个维度密切相关。     

局部晚期鼻咽癌放疗联合同步化疗研究进展

放射治疗是鼻咽癌的标准治疗方法,但由于大多数患者确诊时已属局部晚期或晚期,这类患者单纯放疗后的5年总生存率为59%～75%[1].     

放化疗联合治疗局部晚期鼻咽癌的临床观察

  目的  在局部晚期鼻咽癌根治性放疗联合紫杉醇、顺铂化疗中, 分析同步治疗与序贯治疗对治疗疗效的影响。  方法  144例局部晚期鼻咽癌病例进行随机分组, 同步治疗组: 放疗联合TP同步化疗; 序贯治疗组: 一疗程TP诱导化疗+根治性放疗+3疗程TP辅助化疗。放疗采用三维适形技术, 化疗采用紫杉醇联合顺铂方案。放疗及化疗方案联合治疗与同步治疗相同。  结果  全部病例至少随访2年, 同步治疗组与序贯治疗组: 局部控制率分别为81.2%与76.3%;远处转移率分别为9.7%与19.4%;2年无瘤生存率分别为76.4%与66.7%。  结论  研究表明局部晚期鼻咽癌接受同步放化疗, 无瘤生存率提高, 远处转移率降低; 不良反应与序贯治疗相比, 主要是放射性黏膜炎发生率和严重程度增加, 但经对症处理, 患者一般都能耐受。      

局部晚期鼻咽癌患者生活质量及其影响因素的研究现状

同期放化疗是目前局部晚期鼻咽癌的主要治疗方法，其毒副反应以及疾病本身带来的痛苦严重影响患者的生活质量。本文综述了局部晚期鼻咽癌患者生活质量及影响生活质量的各种因素，指出应制定符合我国自身文化背景的鼻咽癌生活质量测评量表，提高局部晚期鼻咽癌患者的生活质量。     

局部晚期鼻咽癌患者生活质量及其影响因素的研究现状

同期放化疗是目前局部晚期鼻咽癌的主要治疗方法,其毒副反应以及疾病本身带来的痛苦严重影响患者的生活质量.本文综述了局部晚期鼻咽癌患者生活质量及影响生活质量的各种因素,指出应制定符合我国自身文化背景的鼻咽癌生活质量测评量表,提高局部晚期鼻咽癌患者的生活质量.     

局部晚期鼻咽癌患者营养状况及其与预后相关性分析

目的:探讨局部晚期鼻咽癌患者营养状况及其与预后相关性。方法:分析2015年8月至2017年3月湖北省肿瘤医院收治的局部晚期鼻咽癌住院患者53例,联合运用患者主观整体营养评估量表(patient-generated subjective global assessment,PGSGA)、体格测量、血液学指标和放化疗不良反应,全面评估患者营养状况;采用Kaplan-Meier法及Cox风险比例回归模型对患者生存及影响因素进行分析。结果:53例患者中,94.3%(50/53)的患者出现体质量下降,下降均值为(6.89±0.54)kg,50.9%(27/53)的患者体质量下降≥10%;PG-SGA评估的患者重度营养不良发生率为84.9%(45/53);淋巴细胞计数、红细胞、血红蛋白、白蛋白与PG-SGA评分高度负相关(P<0.05),口腔黏膜炎、吞咽困难或疼痛、厌食、体质量下降百分比与PG-SGA评分高度正相关(P<0.05);单因素及多因素分析显示,TNM分期晚、治疗期间体质量下降≥10%与局部晚期鼻咽癌患者预后不良相关,而白细胞计数增加(在正常值范围内)与局部晚期鼻咽癌患者预后...     

局部晚期鼻咽癌放化疗研究进展

局部晚期鼻咽癌治疗失败的原因是局部复发和远处转移.鼻咽癌是对化疗相对敏感的肿瘤,寻找有效的耐受性好的化疗药物以及放化疗的结合方式是近年来的研究热点.目前的试验研究结果显示,局部晚期鼻咽癌的治疗以综合治疗为主,以同期放化疗的方式治疗局部晚期鼻咽癌对改善生存最为肯定,其对总生存率及无进展生存率的显著提高得到了公认.新辅助化疗的作用效果不肯定,而含新的化疗药物如紫杉醇、多西他赛等的新辅助化疗方案取得较好的临床疗效,使新辅助化疗再次获得关注.辅助化疗似乎可以降低远处转移的发生.     

局部晚期鼻咽癌放疗同步ＰＦ方案或顺铂单药的临床对照研究

目的　对比观察顺铂（ＤＤＰ）单药用于局部晚期鼻咽癌同步放化疗与ＤＤＰ联合氟尿嘧啶（５-ＦＵ）方案（ＰＦ方案）同步放化疗的有效性和安全性。方法　７６例局部晚期鼻咽癌分为两组,４０例接受ＰＦ方案同步放化疗（５-ＦＵ５００ｍｇ／ｍ^２静滴,ｄ１～ｄ５;ＤＤＰ８０ｍｇ／ｍ^２静滴,ｄ１,２１天为１周期）,３６例接受ＤＤＰ单药同步放化疗（ＤＤＰ４０ｍｇ／ｍ２静滴,每周１次,共７次）。鼻咽部病灶及颈部阳性淋巴结给予放疗总量为７０Ｇｙ,颈部预防性照射给予放疗量５０Ｇｙ。结果　全部患者均可评价疗效和毒副反应,ＰＦ方案组及ＤＤＰ单药组有效率均为１００％。ＰＦ方案组的１、３年生存率分别为１００％、８５％,ＤＤＰ单药组分别为１００％、８９％（Ｐ＞０.０５）;ＰＦ方案组与ＤＤＰ单药组的３年无进展生存率分别为７７.５％和７５.０％ （Ｐ＞０.０５）;ＰＦ方案组的中位生存时间为５０.６个月,ＤＤＰ单药组为４８.０个月（Ｐ＞０.０５）。两组毒副反应以恶心呕吐、口腔黏膜炎及白细胞减少为主,差异均有统计学意义（Ｐ＜０.０５）。结论　ＤＤＰ单药与ＰＦ方案用于局部晚期鼻咽癌同步放化疗的疗效相近,患者均可耐受,但ＤＤＰ单药组反应较轻。     

The results of three different treatment modalities in patients with locally advanced nasopharyngeal carcinoma

The aim of the study was to evaluate the toxicity and efficacy of 62 patients with locally advanced nasopharyngeal carcinoma (NPC) (stage III, IVA, IVB) treated by three different modalities. Cisplatin was given weekly 35 mg/m²/day or every 3 weeks 100 mg/m²/day during radiotherapy (RT) in all patients. Patients were classified into following three groups: The patients in the group 1 (n = 23) were treated only with concurrent chemoradiotherapy (CCRT). In the group 2 (n = 15), before the CCRT, neoadjuvant chemotherapy, consisting of intravenous cisplatin and docetaxel on day 1, every 3 weeks treatment cycles was administered. In the group 3 (n = 24), adjuvant chemotherapy, consisting of cisplatin on day 1 and 5-flourouracil on day 1 to 5 every 3 weeks was used after CCRT. Three arms were treated with the same RT technique and dose. There was no difference for age, sex, and stage among the groups. Radiotherapy was administered in planned dose for all patients. A total of 82% patients completed planned chemotherapy concurrent with RT. The treatment related adverse effects were mild or moderate in intensity. There was no statistical difference between the groups regarding the treatment responses. Complete response rate of RT was 73.9%, 86.7%, and 87.5%, respectively. Median progression free survival (PFS) and overall survival (OS) were 13, 12, 9 months and 22, 20, 15 months for groups 1, 2, 3, respectively. No difference was observed in median OS and PFS among three groups. In our study, the efficacy and toxicity of neoadjuvant and/or adjuvant chemotherapy with CCRT and CCRT alone were found similar.     

Combined chemo-radiotherapy in locally advanced nasopharyngeal carcinomas

AIM: To provide efficacy and safety data about the combined use of radiotherapy and chemo-radiotherapy in nasopharyngeal carcinoma (NPC).METHODS: We reviewed data of 40 patients with locally advanced NPC treated with induction chemotherapy followed by concomitant chemo-radiotherapy (CCRT) (22/40 patients) or CCRT alone (18/40) from March 2006 to March 2012. Patients underwent fiberoscopy with biopsy of the primitive tumor, and computed tomography scan of head, neck, chest and abdomen with and without contrast. Cisplatin was used both as induction and as concomitant chemotherapy, while 3D conformal radiation therapy was delivered to the nasopharynx and relevant anatomic regions (total dose, 70 Gy). The treatment was performed using 6 MV photons of the linear accelerator administered in 2 Gy daily fraction for five days weekly. This retrospective analysis was approved by the review boards of the participating institutions. Patients gave their consent to treatment and to anonymous analysis of clinical data.RESULTS: Thirty-three patients were males and 7 were females. Median follow-up time was 58 mo (range, 1-92 mo). In the sub-group of twenty patients with a follow-up time longer than 36 mo, the 3-year survival and disease free survival rates were 85% and 75%, respectively. Overall response rate both in patients treated with induction chemotherapy followed by CCRT and in those treated with CCRT alone was 100%. Grade 3 neutropenia was the most frequent acute side-effect and it occurred in 20 patients. Grade 2 mucositis was seen in 29 patients, while grade 2 xerostomia was seen in 30 patients. Overall toxicity was manageable and it did not cause any significant treatment delay. In the whole sample population, long term toxicity included grade 2 xerostomia in 22 patients, grade 1 dysgeusia in 17 patients and grade 1 subcutaneous fibrosis in 30 patients.CONCLUSION: Both CCRT and induction chemotherapy followed by CCRT showed excellent activity in locally advanced NPC. The role of adjuvant chemotherapy remains to be defined.     

Weekly paclitaxel with concurrent radiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma

Purpose

To evaluate the efficacy and toxicity of weekly paclitaxel with concurrent radiotherapy followed by adjuvant chemotherapy (AC) in patients with locally advanced nasopharyngeal carcinoma (NPC).

Methods and materials

Between 2004 and 2007, 54 patients with locally advanced NPC were included in this protocol. Patient characteristics: median age 48; 69% male; 52% World Health Organization (WHO) III; 50% stage III, 50% stage IV. The patients underwent a course of definitive conventional radiotherapy (70 Gy in 7 weeks with 2 Gy/fraction), with concurrent weekly paclitaxel 35 mg/m² from the first to the sixth week of radiation. AC was started 4 weeks after the end of the radiotherapy (RT), paclitaxel 135 mg/m² on day 1 and cisplatin 30 mg/m² on days 1-3 were administered every 4 weeks for two cycles.

Results

Median follow-up was 32 months. Eighty-five percentage of complete response and 15% partial response were achieved at the time of one month after AC. The 3-year actuarial rate of local regional control was 86%; distant metastases-free survival, progression-free survival and overall survival at 3 years were 81%, 69% and 76%, respectively. Forty-nine (91%) patients completed six courses of concurrent chemotherapy with weekly paclitaxel, and 4 (7%) patients delayed at the second cycle of AC. No patient developed severe acute toxicities.

Conclusions

Weekly paclitaxel with concurrent RT followed by AC is a potentially effective and toxicity tolerable method for locally advanced NPC. Further studies are needed to identify the optimal dose of weekly paclitaxel in this strategy.     

局部晚期鼻咽癌放射治疗联合化疗的研究进展

临床Ⅲ ～Ⅳ期鼻咽癌占鼻咽癌的的大多数,根治性放疗联合化疗的综合治疗是局部晚期鼻咽癌治疗的基石,现有的证据表明,同步放化疗是中国局部晚期鼻咽癌标准治疗方法,但放化疗的最佳组合方案仍未确定。本文就这方面的研究进展作一综述。     

口服营养补充对鼻咽癌同期放化疗患者的影响

背景与目的：鼻咽癌患者同步放化疗期间常出现体质量下降及营养不良,进而影响治疗疗效及生活质量。本研究旨在对其进行强化营养咨询和口服营养补充(oral nutritional supplements,ONS),观察对营养状况及生活质量的影响。方法：采用前瞻性、随机对照的方法,以2014年6月—2015年12月在复旦大学附属肿瘤医院放疗科和上海交通大学附属第九人民医院放疗科64例鼻咽癌同期放化疗患者作为研究对象。试验组给予个体化营养咨询和口服营养补充,对照组给予常规治疗。采用生物电阻抗方法及PG-SGA营养评估法,观察营养干预对鼻咽癌同期放化疗患者的营养状况患者主观整体评估(patient-generated subjective global assessment,PG-SGA)评分及人体成分指标,如体质量、体质指数、脂肪组织、去脂组织、体细胞量、骨骼肌量及相位角的影响。结果：同步放化疗期间所有患者人体成分指标均有不同程度的下降,下降程度试验组均好于对照组(P＞0.05);PG-SGA营养评估的评分值,试验组均低于对照组(P＞0.05);生活质量各项评分,试验组均好于对照组(P＞0.05);ONS摄入量大于2/3计划量的患者与对照组相比,人体成分指标如去脂组织指数和骨骼肌量试验组明显好于对照组(P＜0.05);生活质量评分指标如总体健康状况、恶心与呕吐、疼痛及便秘的平均变化值,试验组均小于对照组(P＞0.05)。结论：鼻咽癌患者放化疗期间营养状况下降明显,及时给予口服营养补充可在一定程度上缓解营养状况的进一步下降。