鼻咽癌颈部淋巴结转移综合治疗的远期疗效观察

目的 观察鼻咽癌放化疗配合颈部淋巴结微波热疗的远期疗效.方法 154例初治N2～N3期鼻咽癌患者随机分为对照组(78例)和热疗组(76例).对照组用氟尿嘧啶+顺铂化疗1～2周期(21 d为1周期)后原发灶常规放疗DT 70～78 Gy分35～39次,颈淋巴结转移灶DT 68～72 Gy分34～36次.热疗组放化疗方法同对照组,颈淋巴结于放疗第1周开始配合局部热疗,每次加温45min,2次/周,共8～14次.结果 热疗组、对照组5年颈淋巴结局部控制率分别为97%和77%(X2=14.24,P<0.01),远处转移率分别为37%、44%(X2=0.73,P>0.05),无瘤生存率分别为51%、21%(X2=15.91,P<0.01),总生存率分别为59%、41%(X2=5.09,P<0.05).结论 对N2、N3期鼻咽癌放化疗配合颈淋巴结微波热疗的5年颈淋巴结局部控制率、无瘤生存率和总生存率均优于单纯放化疗组.

Long-term clinical outcome of combined therapy for nasopharyngeal carcinoma with cervical lymph node metastasis

Objective To evaluate long-term efficacy of microwave hyperthermia combined with chemoradiotherapy for nasopharyngeal carcinoma (NPC) with cervical lymph node metastasis. Methods A total of 154 patients with stage N2 or N3 NPC ('92 staging system) were randomized into two groups:microwave hyperthermia combined with chemoradiotherapy (Group A, 76 cases) and chemoradiotherapy alone (Group B, 78 cases). Both of the two groups received 1 -2 cycles of chemotherapy of cisplatin and 5-fluorouracil, followed by conventional radiotherapy of 70 - 78 Gy in 35 - 39 fraction to the nasopharynx and 68 -72 Gy in 34 - 36 fractions to the neck. Group A received microwave hyperthermia to the metastatic cervical nodes at the beginning of radiotherapy. The hyperthermia was given as 45 min every time, twice a week for 8 - 14 times totally. Results The 5-year complete response rates of cervical lymph nodes in group A and B were 97% and 77% (x2 = 14. 24,P<0. 01). The distant metastasis rates in the two groups were 37% and 44% (x2 = 0. 73, P > 0. 05). The disease-free survival rates were 51% and 21% (x2 = 15.91, P <0. 01). The 5-year overall survival rates were 59% and 41%, respectively (x2 = 5.09, P < 0. 05).Conclusions For patients with stage N2 or N3 NPC, microwave hyperthermia combined with chemoradiotherapy can improve the complete response, disease-free survival and overall survival.