局部晚期鼻咽癌IMRT联合化疗±靶向治疗疗效与安全性对比

目的 回顾对比局部晚期鼻咽癌患者IMRT联合化疗±靶向治疗的疗效与不良反应，初步评价放化疗基础上加用靶向药物的必要性。方法 收集2007—2012年间接受IMRT联合同步化疗±辅助化疗加靶向治疗的Ⅲ—Ⅳ_{b期鼻咽癌患者42例(试验组)，同期仅行IMRT联合同步放化疗±辅助化疗的患者与其按1∶4配对入组168例(对照组)。Kaplan-Meier法计算生存率并Logrank检验差异，余用χ²检验。结果 随访率为100%，试验组、对照组3年样本量分别为42例、168例。试验组3年OS、LRFS、DMFS率分别为94%、100%、92%，对照组的分别为87.3%、94.6%、89.1%(P=0.647、0.193、0.744)。3—4级胃肠道不良反应、骨髓抑制及口腔黏膜反应发生率试验组分别为7%(3/42)、26%(11/42)、41%(17/42)，对照组分别为3.6%(6/168)、17.3%(29/168)、14.9%(25/168)(P=0.388、0.272、0.000)。结论 初步结果提示IMRT联合化疗的基础上加用靶向治疗对提高局部晚期鼻咽癌患者OS、LRFS及DMFS的疗效不明显，且有可能加重放化疗相关的口腔黏膜反应。}

Comparison of efficacy and safety between intensity-modulated radiotherapy combined with chemotherapy plus targeted therapy and intensity-modulated radiotherapy combined with chemotherapy for locally advanced nasopharyngeal carcinoma

Objective To retrospectively compare the efficacy and toxicity between intensity-modulated radiotherapy (IMRT) combined with chemotherapy plus targeted therapy and IMRT combined with chemotherapy in the treatment of patients with locally advanced nasopharyngeal carcinoma (NPC), andto preliminarily evaluate the necessity of adding targeted drugs to standard chemoradiotherapy. Methods
Forty-two patients with stage Ⅲ-Ⅳ_b NPC who received IMRT combined with concurrent±adjuvant chemotherapy plus targeted molecular therapy from January 2007 to December 2012 were assigned to experiment group,while 168 patients who received IMRT combined with concurrent±adjuvant chemotherapy within the same period were assigned to control group. The experiment group was paired with the control group at a ratio of 1vs.4.The survival rates were caculated using Kaplan-Meier method and analyzed using log-rank method,other comparison was perfomed by χ²-test. Results The follow-up rate was 100%.The sample size of experiment group and control group were 42 patients and 168 patients. There were no significant differences in the 3-year OS, LRFS, or DMFS rates between the experiment group and the control group (94.3% vs. 87.3%, P=0.647;100.0% vs. 94.6%,P=0.193;92.2% vs. 89.1%, P=0.744).There were also no significant differences in the incidence rates of grade Ⅲ-Ⅳ gastrointestinal reaction or marrow suppression between the two groups (7.1%(3/42) vs. 3.6%(6/168),P=0.388;26.2%(11/42) vs. 17.3%(29/168),P=0.272).However,the experiment group had significantly higher incidence of grade Ⅲ-Ⅳ oral mucositis than the control group (40.5%(17/42) vs. 14.9%(25/168),P=0.000). ConclusionsThe preliminary results indicate that IMRT combined with chemotherapy plus targeted molecular therapy is not able to substantially improve the OS, LRFS, or DMFS rates in patients with locally advanced NPC. Moreover, it may aggravate radiochemotherapy-induced oral mucositis.