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背景与目的:鼻咽癌是常见的头颈部恶性肿瘤,放射治疗是主要的治疗手段,也是主要的根治方法,根据现代放射生物学的研究结果,克隆源性肿瘤细胞在治疗过程中的加速增殖是治疗失败的主要原因,因此,在放射治疗中时间因素越来越受到重视。本研究探讨连续常规分割放射治疗鼻咽癌的价值。方法:116例首程鼻咽癌患者前瞻性随机分组,连续常规分割放射治疗(CCFRT)组56例,常规分割放射治疗(CFRT)组60例。采用6 MV X直线加速器外照射。研究组(CCF):T2-3DT58~62 Gy/29~31 d,T4DT64~66 Gy/32~33 d,No DT46~50 Gy/23~25 d,N1-3DT56~60 Gy/28~30 d,都是每天一次2.0Gy,每周七天。对照组(CF):T2-3DT66~70 Gy/45~47 d,T4DT72~74 Gy/50~51 d,No DT54~56 Gy/37~38 d,N1-3DT64~68 Gy/44~46 d,每天一次2.0 Gy,每周五天。N3期患者均配合化疗。结果:治疗结束时鼻咽病灶临床全消率在CCF组为82.1%,3、6个月时各为91.1%和100%,CF组分别为73.3%、85%和95%,颈淋巴结全消率CCF组为64.3%,3、6个月时各为94.6%和100%,CF组分别是为65%、91.7%和93.3%。3、6个月CT/MR I所示肿瘤全消率CCF与CF各为90.7%(39/43)、96.2(51/53)和83.3%(30/36)、90.2%(46/51)。1、3、5年局控率和生存率CCF与CF比较各为100%、94.6%和85.7%比100%、91.7%和81.7%;98.2%、91.1%和67.9%比98.3%、88.3%和53.3%(以上均P>0.05)。两组早期反应接近,后期损伤(张口困难、口干、听力下降及颈组织纤维化)CCF较CF明显减轻(P<0.05)。结论:CCFRT方案能够缩短全疗程时间,提高局控率和生存率,降低晚期并发症,提高生存质量,是一种可行的治疗方法,本研究尚有待大样本前瞻性随机临床研究和长期观察。
BACKGROUND & OBJECTIVE: Nasopharyngeal carcinoma is a common malignant tumor of the head and neck. Radiation therapy is the primary treatment as well as the main radical method. According to the results of modern radiobiology, the clonogenic tumor cells are accelerated in the course of treatment Proliferation is the main reason for treatment failure, therefore, the time factor in radiation therapy is more and more attention. This study was to investigate the value of continuous conventional radiotherapy for nasopharyngeal carcinoma. Methods: One hundred and sixty-six patients with first-stage nasopharyngeal carcinoma were randomly divided into two groups: 56 cases in CCFRT group and 60 cases in conventional fractionated radiotherapy (CFRT) group. 6 MV X linear accelerator external irradiation. Study group (CCF): T2-3DT 58-62 Gy / 29-31 d, T4DT 64-66 Gy / 32-33 d, No DT46-50 Gy / 23-25 d, N1-3DT 56-60 Gy / 28-30 d , Are 2.0Gy once a day, seven days a week. The control group (CF): T2-3DT 66-70 Gy / 45-47 d, T4DT 72-74 Gy / 50-51 d, No DT 54-56 Gy / 37-38 d, N1-3DT 64-68 Gy / 44-46 d , 2.0 Gy once daily, five days a week. N3 patients with chemotherapy. Results: At the end of treatment, the clinical complete elimination rate of nasopharyngeal lesions was 82.1% in CCF group, 91.1% and 100% in 3,6 months and 73.3%, 85% and 95% in CF group, respectively The rate was 64.3% in the CCF group, 94.6% and 100% at 3 and 6 months, and 65%, 91.7% and 93.3% in the CF group, respectively. At 3 and 6 months, the rates of total cancers CCF and CF were 90.7% (39/43), 96.2 (51/53) and 83.3% (30/36), 90.2% (46/51) . 1, 3, 5 years, the control rate and survival rate of CCF and CF were 100%, 94.6% and 85.7% compared with 100%, 91.7% and 81.7%; 98.2%, 91.1% and 67.9% than 98.3% and 88.3% And 53.3% (all P> 0.05). The CCFs of the two groups were similar to those of the CF group (P <0.05). Conclusion: The CCFRT regimen can shorten the duration of the whole treatment, improve the rate of control and survival, reduce the late complications and improve the quality of life. It is a feasible method for treatment. The large prospective randomized clinical trial and long-term observation are still needed in this study.