【摘要】 目的研究鼻咽癌同期调强放化疗的不良反应和最优化方案。方法2005年2月至2008年3月,55例Ⅱ～Ⅳa期的鼻咽癌患者分成单纯放疗组、同期放化疗加辅助化疗组和同期增敏放化疗加辅助化疗组进行前瞻性研究。体检和影像检查评价近期疗效。CTC3.0评价急性不良反应。结果全部患者随访期6～42个月,中位随访期19个月,随访率100%。局部控制率98.2%。1例15月后局部复发;1例11月后肝转移。患者出现的口干、胃肠道反应、皮肤反应、骨髓抑制和体质量下降均不影响治疗完成。急性口腔黏膜反应使化疗不能按计划进行。放疗结束时22例完全缓解,其中单纯放疗、同期放化疗和同期增敏放化疗分别有8例、8例和6例;33例部分缓解,单纯放疗、同期放化疗和同期增敏放化疗各有11例、21例和1例。结论急性口腔黏膜反应是限制同期调强放化疗完成的主要因素。不含5-Fu方案更能被接受,有可能取得更好效果。更多还原

【Abstract】 Objective A prospective trial was performed to evaluate adverse events of concurrent intensity modulated radiochemotherapy in patients with nasopharyngeal carcinoma,and to discuss the most optimized therapy for the disease.Methods Between February 2005 and March 2008,a prospective trial was performed.55 patients with nasopharyngeal carcinoma(Ⅱ~Ⅳa stage) were separated into radiotherapy alone group,concurrent radiochemotherapy plus adjuvant chemotherapy group and concurrent sensitive radiochemotherapy plus adjuvant chemotherapy group.CT or MRI,combining with clinical health examination were used to evaluate the therapy efficiency.CTC3.0 was adopted to evaluate acute adverse events.Result All the patients were followed-up for 6~24 months,mid-term follow-up period was 19 months.Follow-up rate was 100% and local control rate was 98.2%.Local recurrence was found in one patient after 15 months.Hepatic metastasis was found in one patient after 11 months.Dry mouth,gastrointestinal reaction,skin reaction,bone marrow inhibition and weight loss found in the patients didn’t affect completion of therapy.While acute oral mucosa reaction stopped the chemotherapy being carried out as planned.When radiotherapy was finished,22 patients reached complete remission,8 in radiotherapy alone group,8 in concurrent radio-chemotherapy group and 6 in concurrent sensitive radiochemotherapy group.33 patients reached partial remission,11 in radiotherapy alone group,21 in concurrent radio-chemotherapy group and 1 in concurrent sensitive radiochemotherapy group.Conclusions Acute oral mucosa reaction is the main factor to stop concurrent IMRT being carried out as planned.Concurrent sensitive radiochemotherapy without 5-Fu plus adjuvant chemotherapy is more acceptable to patients,and maybe has better efficiency.更多还原