【摘要】 目的:评价局部晚期鼻咽癌新辅助化疗加同期调强放疗及辅助化疗综合治疗的临床疗效。方法:初治局部晚期鼻咽癌患者135例中,Ⅲ期71例,Ⅳ期64例。122例完成新辅助化疗+同期化疗+辅助化疗,13例由于各种原因只接受了1～4个周期化疗。全组患者均采用全靶区调强放射治疗,处方剂量:GTVnx(69.0～75.9)Gy/(30～33)f、PGTVnx(69.0～69.9)Gy/(30～33)f、PTV1 60.0Gy/(30～33)f、PTV2(50.9～54.0)Gy/(28～30)f、GTVnd(67.5～69.9)Gy/(30～33)f。化疗方案:新辅助化疗和辅助化疗用PF方案,奈达铂(NDP)30mg/(m2.d),d1～d3;5-FU 500mg/(m2.d),d1～d3或5-FU 800mg/(m2.d)持续静脉滴入(CIV)72～120h,21d为1个周期。同步化疗用NDP或DDP 30mg/(m2.d),d1～d3,21d为1个周期。结果:中位随访40个月,3年局部控制率、区域控制率、无远处转移生存率、无瘤生存率、总生存率分别为95.6%、95.6%、85.0%、80.5%和90.4%。结论:调强放疗联合化疗提高了局部晚期鼻咽癌患者的生存率,远处转移仍然是治疗失败的主要原因。更多还原

【Abstract】 OBJECTIVE:To evaluate clinical efficacy and acute adverse events of neoadjuvant chemotherapy plus concomitant chemotherapy and intensity modulated radiotherapy(IMRT) with adjuvant chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma.METHODS:Totally 135 cases with locally advanced nasopharyngeal carcinoma(Stage Ⅲ 71 cases,Stage Ⅳ 64 cases).And 122 cases received neoadjuvant chemotherapy plus concomitant and adjuvant chemotherapy.Thirteen cases received 1-4 courses chemotherapy because of different reasons.All cases adopted intensity modulated radiotherapy.The prescription dose was(69.0-75.9) Gy/(30-33) f to gross target volume to nasopharynx(GTVnx),(69.0-69.9) Gy/(30-33) f to planning gross target volume of nasopharynx(PGTVnx),(67.5-69.9) Gy/(30-33) f to positive neck lymphnodes(GTVnd),60.0 Gy/(30-33) f to planning target volume one(PTV1),(50.9-54.0) Gy/(28-30) f to planning target volume two(PTV2).The regime for neoadjuvant and adjuvant chemotherapy protocol included nedalatin,30 mg/(m2·d),d1-d3,followed by 5-FU 500 mg/(m2·d),d1-d3,or 5-FU 800 mg/(m2·d),CIV for 72-120 h,every 3 weeks.Concurrent chemotherapy protocol included nedaplatin or cisplatin,30 mg/(m2·d),d1-d3,and given every 3 weeks.RESULTS:The median follow-up was 40 months.The 3-year local control rate,regional control rate,distant metastasis-free survival,progression-free and overall survivals were 95.6%,95.6%,85.0%,80.5% and 90.4%,respectively.CONCLUSION:Intensity modulated radiation therapy and chemotherapy for locally advanced nasopharyngeal carcinoma can get good survival with quality of life.更多还原