奈达铂联合紫杉醇同期调强放射治疗初治晚期鼻咽癌的临床观察

目的研究鼻咽癌调强放射治疗（IMRT）的投照方式及放化结合的耐受性和近期临床疗效。方法初治鼻咽癌患者121例中,Ⅲ期84例,Ⅳa期37例。鼻咽和全颈及锁骨上全程实施前7野IMRT技术照射。同时给予紫杉醇＋奈达铂方案化疗2周期,间隔4周。采用Kaplan-Meier法进行生存分析,RTOG标准评价急性反应和晚期损伤。结果中位随访时间16个月,1、2年局部区域无进展生存率分别为95.4%、92.9%;1、2年无远处转移生存率分别为91.6%、87.4%。1、2年总生存率为94.3%、86.7%。患者近期毒副反应可以耐受,口干症状随着治疗后时间的延长口干逐渐减轻。结论IMRT初治鼻咽癌可获得理想的局部区域控制,对正常组织器官有较好的保护作用;紫杉醇＋奈达铂放化综合治疗对控制远处转移有一定价值,毒副反应可以耐受。

Clinical study of first-treated advanced nasopharyngeal carcinoma patients for intensity modulated radiationtherapy(IMRT) combined with paclitaxel and Nedaplatin chemotherapy

Objective To study radiationfields,toleration of radiation therapy combined chemotherapy,clinical efficacy of intensity modulated radiation therapy（IMRT）for first-treated advanced nasopharyngeal carcinoma.Methods From July 2007 to June 2009,121 patients with first-treated advanced nasopharyngeal carcinoma underwent IMRT at the Jiangsu Cancer Hospital.According to the Fuzhou Staging Classification,84 stage Ⅲ,and 37 stage Ⅳ.All of the first-treated nasopharyngeal carcinoma were treated with 7 front radiation fields for full course IMRT including nasopharynx and full neck to supraclavicle.All patients＇ treatment combined with paclitaxel and nedaplatin chemotherapy Kaplan-Meier method was to calculate the local-regional progression-free rate,distant metastasis-free rate,and overall survival.Acute and late toxicities were graded according to RTOG radiation morbidity scoring criteria.Results The 1-,2-year estimated local-regional progression-free survival rates,distant metastases-free survival rates and overall survival rates was 95.4%,92.9%;91.6%,87.4% and 94.3%,86.7%.Conclusions IMRT yields well dose distribution and acceptable toxicity in first-treated nasopharyngeal carcinoma.Radiation therapy combined with chemotherapy is effectors to control distant metastasis.