调强放疗联合同步化疗对局部晚期鼻咽癌的临床观察

目的 回顾性分析调强放疗(IMRT)联合同步化疗对初治局部晚期鼻咽癌的急性不良反应及近期临床疗效。 方法 将本科室2005年1月至2007年1月收治的60例Ⅲ～Ⅳb 期初治的鼻咽癌调强放疗联合同步化疗的患者分为紫杉同步组(32例)和顺铂同步组(28例)。2组均接受调强放疗肿瘤靶区处方剂量68～72 Gy。紫杉同步组同时予以紫杉醇脂质体30 mg/m²,1次/周,共5～7次。顺铂同步组同时予以顺铂30 mg/m²,1次/周,共5～7次。结果 1紫杉同步组发生皮肤及黏膜反应的中位时间分别为4.2、3.0周,较顺铂同步组(3.0、2.0周)有明显的滞后;且顺铂同步组发生中重度皮肤、黏膜、骨髓及胃肠不良反应的概率明显高于紫杉同步组。顺铂同步组体重丢失亦较紫杉同步组严重。2组在肝肾功能损伤上没有明显差别。2紫杉同步组中4例占12.5%的患者,顺铂同步组10例占36%的患者治疗中断。紫杉同步组依从性明显优于顺铂同步组。 两者在中段时间上没有明显差别。两者的2年无瘤生存率及2年生存率差异无统计学意义。结论 紫杉醇脂质体联合同步调强放疗较顺铂联合调强放疗治疗局部晚期鼻咽癌不良反应更低,治疗依从性更好。

Clinical comparative investigation using intensity-modulated radiotherapy combined with concurrent chemotherapy for the local advanced nasopharyngeal carcinoma

Objective To research the early effects and side-effects of the local advanced nasopharyngeal carcinoma patients using intensity-modulated radiotherapy(IMRT)combined with concurrent chemotherapy.Methods From January 2005 to January 2007,60 patients with nasopharyngeal carcinoma of stage m-IV b were received IMRT combined with concurrent chemotherapy in our center.Sixty patients were divided into paclitaxel concurrent group(32 patients)and cisplatin concurrent group(28 patients).The prescribing doses of the primary tumor were 68-72 Gy for each group.The patients of paclitaxel concurrent group patients of the cisplatin concurrent group got earlier radiodennatitis and radiation-induced mucositis but also got significantly higher rate of radiodermatitis,radiation-induced mucositis,radiation-induced leucopenia and gastrointestinal toxicity,as well as the loss of weight.No significant difference was found on liver and renal funcfons between two groups.Four patients(12.5%)of the paclitaxel concurrent group were broken-off,which was much better than the cisplatin concurrent group.There was no significant difference on the specific length of break-off time,the 2-year overall survival rate and the 2-year diseaee-free survival rate between two groups.Conclusions IMRT combined with concurrent chemotherapy of paclitaxel liposome for local advanced nasopharyngeal carcinoma results in less side-effects and better tolerance than IMRT combined with concurrent cisplatin chemotherapy.