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目的探讨微波热疗联合放化疗治疗N2、N3期鼻咽癌颈部淋巴结转移患者的近期疗效。方法将95例N2~N3期、无放化疗及热疗禁忌证的鼻咽癌初治患者随机分为放化热疗组(42例)及放化疗组(53例)。两组均采用瑞典ELEKTA5933型直线加速器,8 MV X线行鼻咽、颈部调强适形放疗(IMRT)根治性外照射,设野及剂量基本相同;化疗采用DDP(20 mg/m2)、5-Fu(2200 mg/m2)和四氢叶酸(120mg/m2)24h灌注,诱导后单药顺铂(DDP方案)与放疗同一天开始,之后3周重复,共3个周期;热疗采用KJ-9000型微波肿瘤热疗仪行颈部淋巴结透热,45-60 min/次,2次/周,6~8次。结果放化热疗组和放化疗组的颈部淋巴结治愈成功率分别为100%和88.7%,差异有统计学意义(P<0.05)。分层分析显示,两组N3期患者的疗效差异有统计学意义,而N2期患者差异则无统计学意义(P>0.05)。结论临床治疗鼻咽癌N2、N3期颈部淋巴结转移患者中,微波热疗联合放化疗的治疗效果更显著,尤其对于N3期患者而言,效果更佳,应在临床治疗中推广使用。
Objective To investigate the short-term curative effect of microwave hyperthermia combined with chemoradiotherapy in patients with N2 and N3 stage cervical lymph node metastases. Methods Ninety-five patients with nasopharyngeal carcinoma from N2 to N3, with no contraindications to radiotherapy and chemotherapy, were randomly divided into radiotherapy and chemotherapy group (n = 42) and radiotherapy and chemotherapy group (n = 53). The two groups were treated with Sweden ELEKTA5933 linear accelerator, 8 MV X line nasopharyngeal, neck IMRT radical external irradiation, set the field and the same dose; chemotherapy using DDP (20 mg / m2) 5-Fu (2200 mg / m2), and tetrahydrofolate (120 mg / m2) for 24h. After induction, cisplatin (DDP regimen) started on the same day as radiotherapy and then repeated for 3 weeks. KJ-9000 microwave tumor hyperthermia instrument neck lymph node diathermy, 45-60 min / times, 2 times / week, 6 to 8 times. Results The success rate of cervical lymphadenectomy in radiochemotherapy group and radiotherapy and chemotherapy group was 100% and 88.7%, respectively, the difference was statistically significant (P <0.05). Stratified analysis showed that there was significant difference in the curative effect between two groups of N3 patients, but no significant difference between N2 patients (P> 0.05). Conclusion In the clinical treatment of patients with N2 and N3 cervical lymph node metastases of nasopharyngeal carcinoma, the therapeutic effect of microwave hyperthermia combined with radiotherapy and chemotherapy is more significant, especially for patients with N3 stage, the effect is better and should be widely used in clinical treatment.