【摘要】 目的:探讨调强适形放疗（IMRT）联合新辅助化疗对上下行型鼻咽癌患者的治疗效果。方法:198例鼻咽癌患者根据肿瘤发展方向分为上行型组（98例）和下行型组（100例）,上行型组根据治疗方式不同分为A₁组（49例）和B₁组（49例）,下行型组根据治疗方式不同分为A₂组（50例）和B₂组（50例）。A₁与A₂组为同期放化疗,B₁与B₂组为新辅助化疗联合序贯同期放化疗。对比各组疗效,放化疗不良反应及远期随访结果。结果:①上行型组与下行型组中B组治疗有效率（B₁=95.9%,B₂=96.0%）均明显高于A组（A₁=81.6%,A₂=82.0%）（P<0.05）。②上行型组与下行型组中B组（B₁=12.2%,B₂=12.0%）与A组（A₁=10.2%,A₂=10.0%）放疗不良反应发生率比较无统计学差异（P>0.05）,但上行型组放疗不良反应多为口腔损伤与听力下降,而下行型组放疗不良反应多为食管损伤与肺损伤,这与放疗照射的部位有关。③上行型组与下行型组中B组（B₁=24.5%,B₂=28.0%）患者化疗不良反应发生率比较差异无统计学意义（P>0.05）。④所有患者均随访18个月,上行型组与下行型组B组（B₁=89.8%,B₂=84.0%）患者生存率明显高于A组（A₁=71.4%,A₂=66.0%）,且B组淋巴结转移率低于A组（均P<0.05）;下行型组远期生存率与上行型组比较无统计学差异（P>0.05）,但其发生淋巴结转移率明显高于上行型组（P<0.05）。结论:不同分型鼻咽癌使用IMRT下同步放化疗联合诱导化疗效果好于IMRT下的同步放化疗。IMRT的不良反应上行型组以口腔损伤与听力下降为主,下行型组以食管损伤与肺损伤为主,下行型组远期更容易发生淋巴结转移,临床治疗应根据患者分型不同进行IMRT照射剂量的改变,以达到最佳效果。更多还原

【Abstract】 Objective:To investigate the effect of intensity-modulated radiotherapy（IMRT） combined with neoadjuvant chemotherapy in the treatment of ascending and descending types of nasopharyngeal carcinoma.Methods:198 patients with nasopharyngeal carcinoma were divided into ascending type group（98 cases） and descending type group（100 cases） according to the development direction of nasopharyngeal carcinoma.According to the different treatment methods,the ascending type group was further divided into group A₁（49 cases） and group B₁ （49 cases）,and the descending type group was further divided into group A₂ （50 cases） and group B₂（50 cases）.The group A₁ and group A₂ were given concurrent chemoradiotherapy,and the group B₁ and group B₂ were given neoadjuvant chemotherapy combined with sequential concurrent chemoradiotherapy.The descending group was divided into A₂ group（50 cases） and B₂ group（50 cases） according to different treatment methods.The efficacy,adverse reactions of concurrent chemoradiotherapy and long-term follow-up results were compared.Results:The efficacy of group B（B₁=95.9%,B₂=96.0%） in the ascending type group and the descending type group was significantly better than that in group A（A₁=81.6%,A₂=82.0%）（P<0.05）.There was no significant difference in the incidence of adverse reactions of radiotherapy between group B（B₁=12.2%,B₂=12.0%） and group A（A₁=10.2%,A₂=10.0%） in the ascending type group and the descending type group（P>0.05）,but the adverse effects of radiotherapy in the ascending type group were mostly oral injury and hearing loss,while those in the descending type group radiotherapywere mostly esophageal injury and lung injury,which was related to the site of radiotherapy exposure.There was no significant difference in the incidence of adverse reactions of chemotherapy between the ascending type group and the descending type group（B₁ = 24.5%,B₂ = 28.0%）（P>0.05）.All patients were followed up for 18 months.The survival rate of group B（B₁=89.8%,B₂=84.0%） in the ascending type group and the descending type group was significantly higher than that of the group A（A₁=71.4%,A₂=66.0%）,and the rate of lymph node metastasis of group B was lower than that of group A（all P<0.05）.The long-term survival rate of the descending type group was not significantly different from that of the ascending type group（P>0.05）,but the rate of lymph node metastasis was significantly higher than that of the ascending type group（P<0.05）.Conclusion:The effect of concurrent chemoradiotherapy combined with induction chemotherapy under IMRT for different types of nasopharyngeal carcinoma is better than that under IMRT.The main adverse reactions of IMRT were oral injury and hearing loss in the ascending type group,and esophageal injury and lung injury in the descending type group.In the long-term,lymph node metastasis is more likely to occur in the descending type group.In order to achieve the best effect,the dose of IMRT should be changed according to different types of patients.The clinical treatment should be based on the patient’s classification to change the dose of IMRT to achieve the best results.更多还原