【摘要】 目的评估同期放化疗方案对局部晚期鼻咽癌患者的疗效、急性毒性反应、依从性和晚期损伤情况。方法74例Ⅲ、Ⅳ期中国人种局部晚期鼻咽癌患者,按照北美Intergroup0099方案接受了同期放疗加辅助化疗的治疗,其急性与晚期毒性反应采用美国放射治疗协作组织(RTOG)的标准进行评价。结果74例患者的5年生存率和无瘤生存率分别为71.3%和43.5%。无5级毒性反应发生,3,4级急性毒性反应主要为造血系统25例,占33.8%;咽部黏膜19例,占25.7%;放疗区皮肤损伤6例,占8.1%。完成放疗、同期放化疗和全部化疗者分别为100.0%、75.7%和47.3%;3～4级晚期并发症主要为唾液腺损伤(17例)、听力损伤(13例)、皮肤及皮下组织损伤(7例),晚期损伤的5年累积发生率为44.3%。结论与常规放射治疗相比,同期放化疗方案有助于中国人种局部晚期鼻咽癌患者疗效的提高,其急性毒性反应有所增加,晚期损伤基本相同。更多还原

【Abstract】 Objective To evaluate the efficacy and toxicity of concomitant chemo-radiotherapy(CCRT) followed by adjuvant chemotherapy (ACT) in Chinese patients with locoregionally advanced nasopharygeal carcinoma (NPC). Methods Seventy-four patients with stage Ⅲ and Ⅳ (UICC1997) were treated by Intergroup 0099 regimen, consisting of CCRT using cisplatin 100 mg/m2 on D1, 22, and 43 of radiotherapy, followed by ACT using cisplatin 80 mg·m -2 ·d -1 and 5-Fu 1 g·m -2 ·4 d -1 given from D71, 99, and 127. All the patients were irradiated with conventional fractionation to a total dose of 68 Gy to the nasopharynx and 66 Gy to the neck. Acute toxicity and late complication were assessed by the RTOG radiation morbidity scoring scheme. Results With a median follow-up of 49 months, the overall 5-year survival and relapse-free survival rates were 71.3% and 43.5% respectively. No grade 5 toxicity was observed in this series, the main grade 3/4 acute toxicity events were hematologic toxicity in 25 patients (33.8%), mucositis in 19 patients (25.7%), and grade 3 skin disease in 6 (8.1%), respectively. The compliance rates were 100.0% for radiotherapy, 75.7% for CCRT, and 47.3% for CCRT plus ACT. The main grade 3/4 late complications were severe salivary gland toxicity (17 cases), ear injury (13 cases), and the neck skin/subcutaneous tissue disease (7 cases). The 5-year cumulative incidence of late toxicity was 44.3%. Conclusion Compared with routine radiotherapy, the concomitant chemo-radiotherapy may improve the outcome of locoregionally advanced NPC in the Chinese patients, with higher incidence of severe acute toxicities and similar late complications.更多还原