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目的:探讨同期放化疗与单纯放疗相比对局部晚期头颈部鳞癌疗效及毒副反应的不同。方法:67例局部晚期头颈部鳞癌患者分为:单纯放疗组(RT)和同期放化疗组(RT+CT),两组放疗方法相同,都使用常规放疗技术,同期放化疗组在放疗同时给予顺铂和氟尿嘧啶4周期化疗,放疗结束后对比两组的近期疗效和不良反应,并对患者进行COX多因素回归分析。结果:两组均完成治疗计划,在放疗结束后1个月和3个月原发灶CR率和颈部淋巴结CR率无明显差异(P>0．05),一年内远处转移率亦无统计学意义(P>0．05)。同期放化疗组的急性毒副反应与单纯放疗组相比明显加重(P<0．05)。COX回归分析显示:肿瘤的TNM分期和治疗方式与肿瘤的预后具有明显相关性(P=0．00),患者的年龄、性别、民族、病理组织类型与肿瘤的预后无明显相关性(P>0．1),有无淋巴结转移有影响肿瘤预后的趋势(P=0．052)。肿瘤TNM分期是预后的危险因素,分期越晚,患者生存期越短;而同期放化疗为保护因素,与单纯放疗相比降低死亡风险达68．7％。结论:同期放化疗的毒副反应较重且明显,但病人可以耐受,与单纯放疗相比可以明显降低患者的死亡风险,是治疗局部晚期头颈部鳞癌的有效方法。
OBJECTIVE: To investigate the efficacy and side effects of concurrent chemoradiotherapy versus radiotherapy alone on locally advanced head and neck squamous cell carcinoma. Methods: Sixty-seven patients with locally advanced head and neck squamous cell carcinoma were divided into radiotherapy group (RT) and concurrent radiotherapy and chemotherapy group (RT + CT). The radiotherapy methods were the same in both groups. Conventional radiotherapy was used. In the same period, radiotherapy At the same time cisplatin and fluorouracil 4 cycles chemotherapy, radiotherapy after the end of the two groups compared the short-term efficacy and adverse reactions, and patients with COX multivariate regression analysis. Results: The treatment plans were completed in both groups. There was no significant difference in CR rate and CR rate between 1 and 3 months after radiotherapy (P> 0.05). There was no distant metastasis within one year Statistical significance (P> 0.05). The acute toxicity of radiotherapy and chemotherapy group was significantly higher than that of radiotherapy alone group (P <0.05). COX regression analysis showed that TNM staging and treatment of tumor had significant correlation with tumor prognosis (P = 0.00). There was no significant correlation between age, gender, ethnicity, pathological type and prognosis (P> 0.1), with or without lymph node metastasis affect the prognosis of the trend (P = 0.052). The TNM stage of the tumor is a risk factor for prognosis. The later stage of the tumor, the shorter the survival period of the patient. The concurrent chemoradiation as the protective factor reduces the risk of death by 68.7% compared with radiotherapy alone. Conclusions: The toxic and side effects of concurrent chemoradiotherapy during the same period are more serious and obvious, but the patient can tolerate. Compared with radiotherapy alone, the chemotherapy can significantly reduce the risk of death and is an effective method for the treatment of locally advanced head and neck squamous cell carcinoma.