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目的 :探讨放疗前贫血对鼻咽癌患者调强放疗(intensity-modulated radiation therapy,IMRT)近期疗效及不良反应的影响。方法 :148例鼻咽癌初诊患者根据放疗前血红蛋白水平分为贫血组(43例)和正常血红蛋白组(105例),局部晚期患者在放疗前先行诱导化疗2个周期(顺铂联合5-氟尿嘧啶),除Ⅰ期以外的所有患者放疗时均进行同期化疗(顺铂)。放疗结束后评价2组患者的近期疗效和不良反应。结果 :放疗结束时,贫血组鼻咽病灶完全缓解(complete response,CR)率为69.8%,部分缓解(partial response,PR)率为30.2%;正常血红蛋白组CR率为85.7%,PR率为14.3%,2组间疗效差异有统计学意义(P=0.025)。放疗结束时,贫血组颈部转移淋巴结CR率为72.1%,PR率为27.9%;正常血红蛋白组CR率为87.6%,PR率为12.4%,2组间疗效差异有统计学意义(P=0.023)。放疗后3个月,2组患者鼻咽病灶CR率均为100%。放疗后3个月,贫血组颈部转移淋巴结CR率为95.3%,PR率为2.3%;正常血红蛋白组CR率为99.0%,PR率为1.0%,2组间疗效差异无统计学意义(P=0.236)。贫血组严重(3~4级)急性黏膜反应的发生率[14.0%(6/43)]少于正常血红蛋白组[26.7%(28/105)],但差异无统计学意义(P>0.05)。结论 :鼻咽癌患者放疗前血红蛋白水平对IMRT的近期疗效影响不明显。
Objective: To investigate the effect of anemia before radiotherapy on short-term efficacy and side effects of intensity-modulated radiation therapy (IMRT) in patients with nasopharyngeal carcinoma. Methods: 148 cases of newly diagnosed nasopharyngeal carcinoma patients were divided into anemia group (n = 43) and normal hemoglobin group (n = 105) according to the level of hemoglobin before radiotherapy. Localized patients were treated with induction chemotherapy for 2 cycles (cisplatin combined with 5-fluorouracil ), All patients except for stage I underwent concurrent chemotherapy (cisplatin) during radiotherapy. After the end of radiotherapy, evaluate the short-term efficacy and adverse reactions of the two groups. Results: At the end of radiotherapy, the complete response (CR) rate of nasopharyngeal lesions was 69.8% and the partial response (PR) rate was 30.2% in anemia group. The CR rate in normal hemoglobin group was 85.7% and the PR rate was 14.3 %, The difference between the two groups was statistically significant (P = 0.025). At the end of radiotherapy, CR rate of cervical lymph node metastasis was 72.1% and PR rate was 27.9% in anemia group, CR rate was 87.6% and PR rate was 12.4% in normal hemoglobin group, the difference was statistically significant (P = 0.023 ). Three months after radiotherapy, CR rates of nasopharyngeal lesions in both groups were 100%. At 3 months after radiotherapy, CR rate of neck lymph node metastasis in anemia group was 95.3% and PR rate was 2.3%. The CR rate of normal hemoglobin group was 99.0% and PR rate was 1.0%. There was no significant difference between the two groups (P = 0.236). The incidence of acute mucosal reaction was significantly lower in anemia patients (grades 3-4) (14.0%, 6/43) than those in patients with normal hemoglobin (26.7%, 28/105), but the difference was not statistically significant (P> 0.05) . Conclusion: The hemoglobin level of patients with nasopharyngeal carcinoma before radiotherapy has no obvious effect on the short-term efficacy of IMRT.