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局部晚期鼻咽癌同期调强放化疗联合辅助化疗的临床疗效

Curative of Concurrent Chemotherapy and Intensity Modulated Radiotherapy Followed by Adjuvant Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma

  • 摘要: 目的观察同期调强放射治疗联合辅助化疗对局部晚期鼻咽癌的临床疗效和不良反应。方法初治局部晚期鼻咽癌患者49例,按92福州分期Ⅲ期30例,ⅣA期19例。鼻咽和上颈部靶体积采用IMRT技术照射,下颈部和锁骨上靶体积采用下颈前切野常规照射。调强放疗设鼻咽大体肿瘤为GTVnx、颈部阳性淋巴结GTVnd 、高危临床靶体积CTV1和低危临床靶体积CTV2。处方剂量分别为GTVnx 73.9Gy/33次、GTVnd及CTV1 66Gy/33次、CTV2(50.4~59.4)Gy/(28~33)次。按EORTC或RTOG标准评价急性反应。全组患者均给与同期化疗,放疗结束予3周期辅助化疗。结果中位随访28月,1、2年局部控制率100%,97.96%,1、2年总生存率(OS) 均为97.96%,1、2年无远处转移生存率95.92%、93.89%。结论局部晚期鼻咽癌同期调强放化疗联合辅助化疗可获得较理想的局部区域控率和总生存率。3~4级急性黏膜炎和3~4级血液系统不良反应是化疗的剂量限制性因素。

     

    Abstract: ObjectiveTo evaluate the clinical effect and toxicities of concurrent chemoradiotherapy using intensity modulated radiotherapy (IMRT)plus adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma. MethodsA total of 49 patients with locally advanced nasopharyngeal carcinoma (according to Fuzhou 92 staging system )were enrolled into this study, 30 patients had stage Ⅲ lesion while 19 patients had stage ⅣA. The regions of nasopharynx and upper neck were irradiated by IMRT technique.The lower neck and the supraclavicular fossa were irradiated with the conventional technique using an anterior field. The prescription doses were 73.9 Gy/33f for the gross tumor volume in the nasopharynx(GTVnx); 66Gy/33f for the positive neck lymph nodes (GTVnx)and the high risk regions (CTV1); and (50.4~59.4)Gy/(28~33)f for low risk regions (CTV2), respectively.Acute toxicities were evaluated according to EORTC/RTOG radiation morbidity scoring criteria .All patients received three cycles of adjuvant chemotherapy followed by concurrent chemoradiotherapy. ResultsWith a median follow-up of 28 months,the l-year local control rate was 100%, and the l-year overall survival and distant metastasis free survival were 97.96%and 95.92%,respectively.ConclusionConcurrent chemoradiotherapy with IMRT plus adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma is a feasible method through to improve the local control rate and worthy of further clinical investigation. Grade 3 to 4 mucositis and grade 3 to 4 hematologictoxicity are considered to be induced by chemoradiotherapy and influence the quality of life.

     

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