不均等分割放疗联合化疗治疗晚期鼻咽癌的效果

目的　观察不均等分割放射治疗联合化疗对晚期鼻咽癌的治疗效果。方法　 5 3例初治晚期鼻咽癌患者分为不均等分割放疗加化疗组 2 9例 (研究组 )和常规分割放疗加化疗组 2 4例 (常规组 )。常规组外照射 (面颈联合野 )DT3 6～ 4 0Gy/ 2 0F、4w后 ,研究组不均等分割放射 (双侧耳前野 )DT3 0～3 3Gy/ 3 0F、3w ,同期加照鼻前野 9Gy/ 6F、3w ,总剂量 75～ 82Gy/ 5 6F、7w ;常规组设双侧耳前野及鼻前野 ,三野交替 ,DT2 7～ 3 0Gy/ 15F、3w ,总剂量 63～ 70Gy/ 3 5F、7w ,两组的化疗方案相同。顺铂 (DDP)2 0mg/m2 ·d ,d1-3,5 氟尿嘧啶 ( 5 FU) 5 0 0mg/m2 ·d ,d1-5,放疗前 1周期、放疗后 2周期。结果　①研究组、常规组鼻咽肿瘤完全消退率分别为 93 .1%、75 .0 % (P <0 .0 5 ) ,颈淋巴结完全消退率分别为96.0 %、75 .0 % (P <0 .0 5 ) ;② 3年生存率两组分别为 82 .7%、70 .8% (P >0 .0 5 ) ;③急性粘膜反应及胃肠道反应两组相似。结论　不均等分割放疗联合DDP + 5 FU方案 ,能显著提高鼻咽部及颈淋巴肿瘤的消退率 ,对晚期鼻咽癌的局部控制率明显高于常规放疗加化疗 ,近期疗效较好 ,是治疗晚期鼻咽癌的有效方法。但 3年生存率无统计学差异 ,其不良反应相似。

Disparity separated radiotherapy combined with chemotherapy in treatment of late-stage nasopharyngeal carcinoma:A prospective study

Objective To observe therapeutic effect of disparity separated radiotherapy combined with chemotherapy for late-stage nasopharyngeal carcinoma.Methods The patients(53) to be initially treated were divided into disparity separated radiotherapy plus chemotherapy group(i.e. study group,29) and routine separated radiotherapy plus chemotherapy group(i.e routine group,24).After routine external radiation (face-neck field,DT 36～40Gy/20F,4w),study group was subjected to disparity separated radiation (bilateral anterior field of ears,DT 30～33Gy/30F,3w),plus synchronis radiation of anterior field of nose(9Gy/6F,3w),total dosage was 75～82Gy/56F,7w;Routine group's radiations were at bilateral anterior field of ears and anterior field of nose,for the three fields,radiated alternatively,DT27～30Gy/15F,3w.Total dosage was 63～70Gy/35F,7w.The chemotherapy schemes were same in two groups,i.e. cisplatin(DDP) 20mg/m 2·d,d 1～3 ,fluorouracil(5-FU) 500mg/m 2·d,d 1～5 ,one cycle before radiotherapy and two cycles after radiotherapy.Results In study and routine groups,whole degradation rates of nasopharyngeal neoplasms were 91.1%, 75.0% ,of neck lymph node were 96.0%,76.0% respectively(P<0.05);The survival rates of three years were 82.7%,70.8% respectively (P>0.05);Acute mucosal and gastroenteric responses were similar.Conclusion The scheme of disparity separated radiotherapy combined with DDP+5-FU may significantly enhance degradation rate of nasopharyngeal and neck lymph neoplasms,and its local control rate for late-stage nasopharyngeal carcinoma obviously is higher than that of routine radiation plus chemotherapy,also short-term effect is better.Thus it is effective method in treatment of late-stage nasopharyngeal carcinoma.But,survival rate of three years has not great difference,and has similar adverse responses.