论文部分内容阅读
目的:评价局部晚期鼻咽癌新辅助化疗加同期调强放疗及辅助化疗综合治疗的临床疗效。方法:初治局部晚期鼻咽癌患者135例中,Ⅲ期71例,Ⅳ期64例。122例完成新辅助化疗+同期化疗+辅助化疗,13例由于各种原因只接受了1～4个周期化疗。全组患者均采用全靶区调强放射治疗,处方剂量:GTVnx(69.0～75.9)Gy/(30～33)f、PGTVnx(69.0～69.9)Gy/(30～33)f、PTV1 60.0Gy/(30～33)f、PTV2(50.9～54.0)Gy/(28～30)f、GTVnd(67.5～69.9)Gy/(30～33)f。化疗方案:新辅助化疗和辅助化疗用PF方案,奈达铂(NDP)30mg/(m2.d),d1～d3;5-FU 500mg/(m2.d),d1～d3或5-FU 800mg/(m2.d)持续静脉滴入(CIV)72～120h,21d为1个周期。同步化疗用NDP或DDP 30mg/(m2.d),d1～d3,21d为1个周期。结果:中位随访40个月,3年局部控制率、区域控制率、无远处转移生存率、无瘤生存率、总生存率分别为95.6%、95.6%、85.0%、80.5%和90.4%。结论:调强放疗联合化疗提高了局部晚期鼻咽癌患者的生存率,远处转移仍然是治疗失败的主要原因。
OBJECTIVE: To evaluate the clinical efficacy of neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma combined with IMRT and adjuvant chemotherapy. Methods: Among 135 patients with newly diagnosed locally advanced nasopharyngeal carcinoma, 71 were in stage Ⅲ and 64 in stage Ⅳ. 122 cases completed neoadjuvant chemotherapy plus concurrent chemotherapy plus adjuvant chemotherapy, 13 cases received only 1 to 4 cycles of chemotherapy for various reasons. All the patients were treated with IMRT. The prescription dose of GTVnx (69.0-75.9) Gy / (30-33) f, PGTVnx (69.0-69.9) Gy / (30-33) f, PTV160.0Gy / (30-33) f, PTV2 (50.9-54.0) Gy / (28-30) f, GTVnd (67.5-69.9) Gy / (30-33) f. Chemotherapy regimen: PF regimen for neoadjuvant chemotherapy and adjuvant chemotherapy with NDP 30mg / (m2.d), d1-d3; 5-FU 500mg / (m2.d), d1-d3 or 5-FU 800mg /(m2.d) continuous intravenous infusion (CIV) 72 ~ 120h, 21d for a cycle. Synchronous chemotherapy with NDP or DDP 30mg / (m2.d), d1 ~ d3, 21d for a cycle. Results: The median follow-up of 40 months was 95.6%, 95.6%, 85.0%, 80.5% and 90.4% respectively at 3 years of local control, regional control, distant metastasis-free survival, . Conclusion: IMRT combined with chemotherapy improves the survival rate of patients with locally advanced nasopharyngeal carcinoma, distant metastasis is still the main reason for treatment failure.