局部晚期鼻咽癌诱导化疗加IMRT同期化疗与IMRT同期化疗的远期疗效比较

doi:10.3760/cma.j.issn.1004-4221.2014.02.013

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摘要目的比较局部晚期鼻咽癌患者诱导化疗+IMRT同期化疗与IMRT同期化疗的远期疗效。方法回顾分析2001—2008年收治的278例局部晚期鼻咽癌患者资料,其中IMRT同期化疗133例,诱导化疗+IMRT同期化疗145例。结果随访率为96.6%。全组患者5年OS为78.1%,DMFS为78.0%,LRFS为90.6%,PFS为72.0%。IMRT同期化疗和诱导化疗+IMRT同期化疗的5年OS、DMFS、RFS、PFS分别为79.9%和76.4%(P=0.443)、77.1%和78.9%(P=0.972)、91.6%和89.8%(P=0.475),71.6%和72.2%(P=0.731)。亚组分析显示T_3~4N_0~1期患者诱导化疗+IMRT同期化疗并未明显改善LRFS (90.7%∶86.9%,P=0.376),N晚期患者诱导化疗+IMRT同期化疗也并未明显改善MFS (57.6%∶ 69.7%,P=0.275)。诱导化疗+IMRT同期化疗的中性粒细胞减少、血红蛋白减少和上消化道反应明显增加(100∶52,P=0.000;64∶35,P=0.010;90∶63,P=0.044)。结论对局部晚期鼻咽癌患者,与IMRT同期化疗相比,诱导化疗+IMRT同期化疗并未明显改善患者预后,且≥3级中性粒细胞减少、血红蛋白减少和上消化道反应明显增加。诱导化疗在局部晚期鼻咽癌治疗中的作用仍需进一步研究。

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	关莹
	孙学明
	曾雷
	陈春燕
	韩非
	卢泰祥

关键词 ：鼻咽肿瘤/放化疗法, 放化疗法, 同期, 放射疗法, 调强, 预后

Abstract：Objective To compare the long-term efficacy between two radiochemotherapy regimens for locally advanced nasopharyngeal carcinoma (NPC):intensity-modulated radiotherapy with concurrent chemotherapy (CCRT) versus neoadjuvant chemotherapy (NACT) followed by CCRT. Methods A retrospective analysis was performed on the clinical data of 278 patients with locally advanced NPC who were admitted to our hospital from 2001 to 2008. Of the 278 patients, 133 received CCRT, and 145 received NACT followed by CCRT (NACT+CCRT). Results The follow-up rate was 96.6%. The 5-year overall survival (OS), distant metastasis-free survival (DMFS), recurrence-free survival (RFS), and progression-free survival (PFS) were 78.1%, 78.0%, 90.6%, and 72.0%, respectively. There were no significant differences between the CCRT group and NACT+CCRT group in 5-year OS (79.9% vs. 76.4%, P=0.443), DMFS (77.1% vs. 78.9%, P=0.972), RFS (91.6% vs. 89.8%, P=0.475), and PFS (71.6% vs. 72.2%, P=0.731). Subgroup analysis showed that compared with CCRT, NACT+CCRT did not significantly improve 5-year RFS in T_3-4N_0-1 patients (90.7% vs. 86.9%, P=0.376) and did not significantly improve 5-year DMFS in patients with advanced N-stage disease (57.6% vs. 69.7%, P=0.275). There were significantly higher numbers of individuals with neutropenia, decrease in hemoglobin, and upper gastrointestinal reactions in patients treated with NACT+CCRT than in those treated with CCRT (100 vs. 52, P=0.000;64 vs. 35, P=0.010;90 vs. 63, P=0.044). Conclusions Compared with CCRT, NACT+CCRT does not significantly improve the prognosis in patients with locally advanced NPC and leads to significant increases in grade ≥3 toxicities (neutropenia, decrease in hemoglobin, and upper gastrointestinal reactions). The role of NACT in the treatment of locally advanced NPC needs further study
   DOI:10.3760/cma.j.issn.1004-4221.2014.02.013
   作者单位:510060 广州,华南肿瘤学国家重点实验室中山大学肿瘤防治中心放疗科
   通信作者:卢泰祥,Email:lutx@mail.sysu.edu.cn

Key words： Nasopharyngeal neoplasms/ radiochemotherapy Radiochemotherapy, concurrent Radiotherapy, intensity-modulated radiotherapy Prognosis

收稿日期: 2013-10-20

作者简介: 卢泰祥, Email:lutx@mail.sysu.edu.cn

引用本文:

关莹,孙学明,曾雷等. 局部晚期鼻咽癌诱导化疗加IMRT同期化疗与IMRT同期化疗的远期疗效比较[J]. 中华放射肿瘤学杂志, 2014, 23(2): 131-134.

Guan Ying,Sun Xueming,Zeng Lei et al. Comparison of long-term efficacy between intensity-modulated radiotherapy with concurrent chemotherapy and neoadjuvant chemotherapy followed by intensity-modulated radiotherapy with concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2014, 23(2): 131-134.

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