【作者】 尤庆山； 刘珊珊； 李香兰； 阎风玉；

【Author】 You Qing-Shan Liu Shan-Shan Li Xiang-Lan Yan Feng-Yu Deparpment of radiation Oncology, The Affiliated Tumor Hospital, Harbin Medical University, Harbin 150081, China

【机构】 哈尔滨医科大学附属肿瘤医院放疗科；

【摘要】 目的:评价羟基喜树碱与放热“三联”综合治疗头颈部晚期和复发癌的治疗反应和疗效。方法:不能手术或不能切除的头颈部癌,术后和／或放疗后复发癌,颈部巨大淋巴结转移癌≥N2,KPS≥60分者进入本组。1998年2月至2003 年12月,收治头颈部癌60例,除5例放疗后复发癌直接分到试验组外,其余56例随机分为热放化组(试验组),放化组(对照组1)和单放组(对照组2),每组各20例。放疗采用4和／或 8MVXX线直线加速器,照射范围包括原发灶、淋巴结转移灶和淋巴结引流区,对放疗后复发灶仅照射局部。2000年以后,采用CT模拟机定位,采用等中心或三维适形放射技术。照射量DT:55-76Gy／5．5-7．5周。热疗采用915MHz微波热疗机,微机自动测温,测热水袋下病灶表面皮肤病人最大耐受温度,60分钟／次,1次／周,6—7次为一疗程。化疗采用羟基喜树碱(HCPT),10mg／次,连用10-15天,放疗后进行, 逢热疗日时,与热疗同时进行。结果:20例热疗病人中,9 例肿瘤表面温度达47℃,6例达46℃,5例达45℃。三组对头颈部癌均有效,热放化组疗效率最高,肿瘤完全消失 (CR)14(70％)例,高于放化组10(50%)和单放组7(35％) 例。热放化组热疗后2例在热疗区出现了小水疱。热放化组Ⅱ级急性黏膜反应7例多于放化组5例和单放组3例。热放化组6例白细胞下降3×109／L,放化组5例,单放组为零。红细胞和血小板各组均正常。热放组3、5年生存分别为8／ 13(61．5％)和6／11(54．5％,放化组为6／11(54．5％)和 4／7(42．9％),单放组为5／12(41．6％)和2／8(25．0%)。 1例颈部二次放疗后复发热放化治疗后局部颈部纤维化未加重,颈部未出现明显肿胀。结论:羟基喜树碱与放热“三联”综合治疗头颈部晚期和复发癌副作用没有明显增加,安全,有效。更多还原

【Abstract】 Objective: To evaluate the efficacy and side effects of the patients with advanced or recurrent head and neck cancer were treated with the three differnce Methods: From Feberary 1998 to.Deceber 2005, Except for 5 with postradiotherapeutic recurrent tumor mass, 55 patients with advanced or postoperative recurrent head and neck cancer were randomly treated with the three differnce methods. Of 60 cases ,15 and the 5 with recurrent lesions were treated with 10-hydroxycamptothecein(HCPT) combined with radiotherapy and hyperthermia.(group A) 20 with HCPT combined with radiotherapy( group B) and 20 radiotherapy alone(group C). The primary sites of the patients included huge metastastic cancer of neck lymph nodes, advanced and/or recurrent carcinoma of laryn-geal maxillary sinus, tonsil and tongue ,and postradiotherapeutic recurrence of metastastic neck lymph node. Among the 60 cases, 59 were squamous ,1 mucoepi-dermoid carcinoma. Hyperthermia:heating of the cancers were performed using 915MHz microwave applicator. The teperature between under water bag and skin suface of the tumors were measured according to the patient,s tolerance to heating. Hyperthermia was started 30 min after radiation and continued for 60 min once a week for 5 - 6 sessions.Radiotherpy: The 4 and/or 8 MV X-ray was used for radiation. Except for 3 patients were given conventional radiotherapy, the others were given three dimensional simulation and isocentic radiotherapy or 3D conformal radiotherapy, tumor dose was 55 - 76Gy/5 - 7 weeks . Chemotherapy: At the beginning of the radiotherapy HCPT 10 mg was intravenously daily administered on 10 -15 days after radiotherapy. On the days of heating HCPT and hyperthermia were concomitantly carried out. Results: Of the 20 patients in group A, 47 ℃ reached in 9 cases, 46 ℃ in 6 cases, 45 ℃ in 5 cases and 44 ℃ in 1 case. Side-effects associated with heating was small blisters, which occurred in two patients. Grade 2 acute mumositis was observed in 7 cases of group A, 5 of group B and 3 of group C. Platlet and red blood cells of all of the groups were not changeable, The overall response rate(CR+PR) of the three groups was 100%( 60/60), with 70% patients achiving complete response in group A, 50% in group B and 35% in group C. With a median follow up 38.2 months, 3, 5-year survival rate was 8/13 ( 61.5% ) and 6/11 (54.5%)in group A, 6/11 (54.5%)and 4/7(42.9%) in group B and 5/12 (41.6% ) and 2/8 ( 25.0% ) in group C . The local fibrosis of the patient who received third radiotherapy was not aggravated. Conclusion: HCPT combined with radiotherapy and hyperthermia is safe and efficient modality for patients with advanced or recurrent head and neck cancer.更多还原