后程加速超分割放疗联合同步化疗治疗晚期鼻咽癌

 目的　探讨后程加速超分割放疗联合同步化疗治疗Ⅲ期、ⅣA期鼻咽癌的疗效。方法　将116例Ⅲ期、ⅣA期鼻咽癌确诊患者随机分为单放组（38例）、同步放化疗组（39例）和后程加速放化疗组（39例）。单放组给予60Coγ线和深部X线常规外照射，面颈联合野剂量达36～38 Gy后，改双侧耳前野，鼻咽部照射总量70～75 Gy，颈部转移灶预防照射量为50 Gy，总剂量达70～80 Gy；同步放化疗组同时给予5-氟尿嘧啶（5-Fu）＋顺铂（DDP）的FP方案化疗，共2周期；后程加速同步放化疗组在鼻咽部剂量达36～38 Gy后，改双侧耳前野加速超分割放疗，1.3 Gy／次，2次／d，间隔6 h以上，鼻咽部总剂量69.8～75 Gy，化疗方案同同步放化疗组。结果　后程加速放化疗、同步放化疗、单纯放疗三组有效率分别为94.9 %、89.7 %、76.3 %，其中单纯放疗组原发肿瘤消退率明显高于后程加速放化疗组，差异具有统计学意义（P < 0.05）。三组1、2、3年局控率分别为100 ％、97.4 ％、89.5 ％，94.9 ％、84.6 ％、68.4 ％和89.7 ％、74.4 ％、57.9 ％；1、2、3年生存率分别为100 ％、92.3 ％、84.2 ％，89.7 ％、84.6 ％、71.0 ％和79.5 ％、76.9 ％、57.9 ％。局控率和生存率后程加速放化疗组均明显高于单放组（P < 0.05），但后程加速放化疗组与同步放化疗组、同步放化疗组与单放组之间差异无统计学意义。结论　后程加速超分割联合同步化疗治疗晚期鼻咽癌能进一步提高肿瘤的近期疗效，提高肿瘤的局控率和患者的生存率，值得临床推广和进一步研究。

Later course accelerated hyperfractionated radiotherapy combined with chemotherapy for advanced nasopharyngeal carcinoma

Objective To evaluate the treatment effect of later course accelerated hyperfractionated radiotherapy with chemotherapy for stage Ⅲ and ⅣA nasopharyngeal carcinoma. Methods 116 patients with stage Ⅲand Ⅳ s nasopharyngeat carcinoma were randomly divided into three groups: the conventional fractionation radiotherapy(CFR, 38 cases), the concurrent radiochemotherapy group(CCRT, 39 cases) and the later course accelerated hyperfractionated radiotherapy combined with chemotherapy group (LCAF+CT, 39cases). CFR group was treated with 60Co γ rays and X rays. When the patients had received the dose of 36～38 Gy through composite faciocervical fields, changed into preauricular fields, the total dose was 70 ～75 Gy.And the total dose of cervical metastasis lymph nodes were 70～80 Gy. CCRT group was treated with DDP and 5-Fu. LCAF+CT group was treated with accelerated hyperfractionated radiotherapy. When the dose of composite faciocervical fields had reached 36～38 Gy, changed the fields and treated with accelerated hyperfractionated radiotherapy, 1.3 Gy/fraction, twice daily. The total dose was 69.8～75 Gy. And the chemotherapy drugs was similar to CCRT group. Results The positive response rate among LCAF+CT, CCRT and CFR groups were 94.9 %, 89.7 %, 76.3 % respectively. The complete response rate in the nasopharyn of LCAF+CT group was higher than CFR group(P ＜0.05). The local control rates of one, two and three year of three groups were 100 %, 97.4 %, 89.5 %, 94.9 %, 84.6 %, 68.4 % and 89.7 %, 74.4 %, 57.9 %respectively; and the survival rates of one, two and three year of three groups were 100 %, 92.3 %, 84.2 %;89.7 %, 84.6 %, 71.0 % and 79.5%, 76.9 %, 57.9 % respectively. There were obvious difference between LCAF+CT and CCRT groups in local control rate and survival rate. But there were no difference between LCAF+CT group and CCRTgroup, and also between CCRT group and CFR group. Conclusion The later course accelerated hyperfraetionated radiotherapy combined with chemotherapy can promote disappearance of primary lesion and improve the local control rate and survival rate of patients with stage Ⅲand ⅣA nasopharyngeal carcinoma.