吴伟莉;孙艳;徐博;
WU Weili1,SUN Yan2,XU Bo2(1.Department of Oncology,The Affiliated Hospital of Guiyang Medical College,Guiyang 550004,China;2.Department of Radiation Oncology,Clinical Oncology College,Beijing University,Beijing 100036,China)

• 1:贵阳医学院附院肿瘤科
• 2:北京大学临床肿瘤学院放疗科
• 3:北京大学临床肿瘤学院放疗科 贵州贵阳550004
• 4:北京100036

摘要(Abstract)：

目的:观察以后程三维适形放疗(3DCRT)为主治疗初治鼻咽癌的临床疗效及毒副反应。方法:38例初治鼻咽癌患者,接受以后程3DCRT为主的治疗。化疗方案为顺铂(DDP)加5-氟尿嘧啶(5-Fu)同期或诱导1~4个周期(中位2个周期)。结果:中位随访34个月,死亡5例。全组1、2、3年生存率和局部控制率分别为100%、91.2%、81.6%和97.3%、94.4%、82.2%。放化综合治疗组1、2、3年生存率和局部控制率分别为100%、88.2%、80.2%和94.4%、88.8%、76.2%,单纯放疗组1、2、3年生存率和局部控制率分别为100%、94.1%、82.3%和100%、100%、87.5%,两组进行比较,生存率和局部控制率差异均无显著性(P>0.05)。毒性反应较低,均能按时完成治疗。结论:后程3DCRT用于鼻咽癌治疗,配合足够周期的化疗,可望达到更好的局部控制率和降低远处转移率。
Objective: To observe the curative results and toxic or side effect of three dimensional conformal radiotherapy(3DCRT) in the treatment of untreated nasopharyngeal carcinoma(NPC).Methods: Thirty-eight patients with NPC received 3DCRT as the first-line treatment.According to the 1992 Fuzhou staging system,patients were identified as: 1 at stage Ⅰ,9 at stage Ⅱ,16 at stage Ⅲ,and 12 at stage Ⅳa.All the patients were divided into radio-chemical combination treatment group(RCG,19 cases) and radiotherapy only group(RTG,19 cases).Patients in group RCG received concomitant chemorradiation or new-adjuvant chemotherapy 2 cycles(range,1-4cycle) with DDP and 5-FU.An initial conventional fraction 36 Gy/18 f/24 d for face and neck port was given to all of the patients,and then,3DCRT was used in nasopharyngeal region 34-46 Gy/17-23 f/24-34 d.The nasopharyngeal region was given radiotherapy with a median of 76 Gy(range,70-82 Gy).The neck with lymph note metastasis was given radical radiotherapy with a median of 50 Gy(range,60-80 Gy).Node-negative neck was given prophylatic radiotherapy with a median of 50 Gy(range,40-60 Gy).Results: The median follow-up period was 34 months.Five patients died.The general 1-,2 and 3-year survival rates and regional control rates were 100%,91.2%,81.6% and 97.3%,94.4%,82.2%,respectively.Those of patients in group RCG were 100%,88.2%,80.2% and 94.4%,88.8%,76.2%,and in group RTG were 100%,94.1%,82.3% and 100%,100%,87.5%,respecttively.No obvious difference was found between the two groups(P>0.05).There were less toxicities during the treatment.All of the patients accomplished the treatment on schedule.Conclusion: A better regional control and less distant metastasis can be obtained in NPC by using 3DCRT combing with enough chemotherapy cycles.

关键词(KeyWords)： 鼻咽肿瘤;放射疗法;顺铂;氟尿嘧啶;三维适形放疗
nasopharyngeal neoplasms;radiotherapy;cisplatin;fluorouracil;three dimensional conformal radiotherapy

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 吴伟莉;孙艳;徐博;
WU Weili1,SUN Yan2,XU Bo2(1.Department of Oncology,The Affiliated Hospital of Guiyang Medical College,Guiyang 550004,China;2.Department of Radiation Oncology,Clinical Oncology College,Beijing University,Beijing 100036,China)

Email:

DOI: 10.19367/j.cnki.1000-2707.2007.05.011

参考文献(References)：

• [1]罗伟,张恩罴,钱建扬,等.改进鼻咽癌外照射技术的前瞻性临床研究[J].癌症,2000(9):903-905.
• [2]蒋国梁.现代肿瘤放射治疗[M].上海科学技术出版社,2003:146.
• [3]Farias TP,Dias FL,Lima RA,et al.Prognostic factors and outcome for nasopharyngeal carcinoma[J].ArchOtolaryngol Head Neck Surg,2003(7):794-799.
• [4]Kam MK,Chau RM,Petruzzli GJ,et al.Intensity-modu-lated radiotherapy in nasopharyngeal carcinoma:dosimeticadvantage over conventional plans and feasibility of doseescalation[J].Int J Radiat Oncol Biol Phys,2003(56):145-157.
• [5]Cozzi L,Fogliata A,Bolsi A,et al.Three-demensionalconformal vs.intensity-modulated radiotherapy in head-and-neck cancer patients:comparative analysis of dosime-tric and technical parameters[J].Int J Radiat Oncol BiolPhys,2004(58):617-624.
• [6]罗伟,邓小武,卢泰详.早期鼻咽癌三维适形、常规和传统外照射计划的剂量学评价[J].癌症,2004(5):605-608.
• [7]Pignon JP,Bourhis J,Domenge C,et al.Chemotherapyadded to locoregional treatment for head and neck squa-mous-cell carcinoma:three-meta-analyses of updated indi-vidual data.MACH-NC Collaborative Croup.Meta-Analy-sis of Chemothereapy on Head and Neck Cancer[J].Lan-cet,2000(355):949-955.
• [8]Langendijk JK,Leemans ChR,Buter J,et al.The addi-tional Value Of Chemotherapy to Radiotherapy in LocallyAdvanced Nasopharyngeal Carcinoma:aMeta-analysis ofthe Published Literature[J].J Clin Oncol,2004(22):4604-4612.
• [9]赵充,卢泰祥,韩非,等.139例鼻咽癌调强放疗的临床研究[J].中华放射肿瘤学杂志,2006(1):1-6.

文章评论(Comment)：