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目的探讨三维适形放射治疗加同期化疗对局部晚期鼻咽癌患者局部控制率和生存率的影响。方法32例T3￣4N1￣3M0鼻咽癌患者应用三维适形放射治疗定位方法和计划系统先进行左右对穿面颈联合野+中下颈、锁骨上区前后切线野常规分割放射治疗,剂量40Gy/20次,4周;然后将面颈联合野后界前移避开脑干脊髓,其他边界不变,后上颈应用8￣12MeV电子线,中下颈、锁骨上区照射野不变,总量10Gy/5次,1周;最后应用三维适形放射治疗进行肿瘤加量,4Gy/次,3次/周,共5￣8次。在放疗第1、22、43天接受顺铂每日30mg/m2,静脉滴注,第1～3天;5-氟尿嘧啶每日500mg/m2,静脉滴注,第1～3天同期化疗。结果32例中,12例完全缓解(CR),17例部分缓解(PR),3例稳定(NC),总有效率(CR+PR)为90.6%。1,2,3,4年生存率分别为100%,93.8%,84.4%,71.9%,4年局部控制率为97.9%。结论三维适形放射治疗加同期化疗对局部晚期鼻咽癌患者有较好的局部控制率和生存率,且能耐受。
Objective To investigate the effect of three-dimensional conformal radiotherapy plus concurrent chemotherapy on the local control rate and survival rate in patients with locally advanced nasopharyngeal carcinoma. Methods 32 patients with T3 ~ 4N1 ~ 3M0 nasopharyngeal carcinoma using three-dimensional conformal radiotherapy positioning method and planning system for the first left and right on the face and neck combined field + middle and lower neck, supraclavicular area tangent field conventional segmentation radiation therapy, dose 40Gy / 20 times, 4 weeks; then face and neck joint field back to avoid brain stem spinal cord, the other boundaries remain unchanged after the neck application of 8 ~ 12MeV electronic line, in the neck, supraclavicular irradiation field unchanged, The total amount of 10Gy / 5 times a week; the last application of three-dimensional conformal radiotherapy for tumor dosage, 4Gy / time, 3 times / week, a total of 5 to 8 times. Cisplatin 30 mg / m 2 was intravenously administered on days 1, 22 and 43 of radiotherapy day 1 to 3; and 5-Fluorouracil daily 500 mg / m 2 was intravenously dripped and the first to third days of concurrent chemotherapy were administered. Results Of the 32 cases, 12 were complete remission (CR), 17 were partial remission (PR), 3 were stable (NC), and the total effective rate (CR + PR) was 90.6%. The 1, 2, 3, 4-year survival rates were 100%, 93.8%, 84.4%, 71.9%, respectively, and the 4-year local control rate was 97.9%. Conclusion Three-dimensional conformal radiotherapy combined with concurrent chemotherapy has better local control rate and survival rate in patients with locally advanced nasopharyngeal carcinoma, and can tolerate.