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目的探讨同步放化疗联合同期~(125)I粒子植入治疗进展期鼻咽癌的效果和安全性。方法 57例进展期鼻咽癌患者随机分为对照组29例和观察组28例,对照组给予调强适形放疗(intensity modulated radiation therapy,IMRT),并于放疗结束15d后给予同步TP方案(多西他赛+顺铂)化疗,21d为1个周期,2次化疗间隔时间为21d,化疗6个周期;观察组IMRT及TP化疗方案同对照组,并于首次放疗5d后植入~(125)I粒子。评价2组治疗期间近期不良反应;治疗完成后6个月评定2组局部控制率和疗效;随访观察2组局部控制率、无瘤生存率、总生存率和治疗失败原因。结果 2组均完成IMRT及6个周期化疗,无失访病例;治疗期间2组放射性皮炎、黏膜炎、吞咽困难、口腔干燥、骨髓抑制、胃肠道反应、味觉障碍发生率比较差异均无统计学意义(P>0.05);治疗完成后6个月,观察组局部控制率(100.0%)高于对照组(82.8%)(P<0.05),治疗有效率(100.0%)与对照组(96.6%)比较差异无统计学意义(P>0.05);观察组治疗后1a、2a、3a、4~5a、6~8a局部控制率(100.0%、100.0%、85.7%、75.0%、60.7%)均高于对照组(86.2%、82.8%、72.4%、58.6%、37.9%)(P<0.05),无瘤生存率(100.0%、92.8%、78.6%、67.9%、57.1%)均高于对照组(86.2%、79.3%、65.5%、51.7%、34.5%)(P<0.05),总生存率(100.0%、96.4%、85.7%、78.6%、64.3%)均高于对照组(100.0%、89.7%、72.4%、58.6%、41.4%)(P<0.05);对照组总失败率(65.5%)、鼻咽局部复发或未控率(13.8%)、区域淋巴结转移+远处转移率(34.5%)高于观察组(42.9%、3.5%、21.4%)(P<0.05)。结论同步放化疗联合同期~(125)I粒子植入近距离治疗进展期鼻咽癌可提高疗效、降低远处转移发生率,且不增加不良反应。
Objective To investigate the efficacy and safety of concurrent chemoradiotherapy combined with ~ (125) I seed implantation for advanced nasopharyngeal carcinoma. Methods Fifty-seven patients with advanced NPC were randomly divided into control group (n = 29) and observation group (n = 28). The control group was given intensity modulated radiation therapy (IMRT), and the TP protocol was given 15 days after the end of radiotherapy Docetaxel + cisplatin) chemotherapy, 21d for a cycle, 2 chemotherapy interval of 21d, 6 cycles of chemotherapy; observation group IMRT and TP chemotherapy with the control group, and after the first radiotherapy 5d implantation ~ ( 125) I particles. Two groups of local adverse reactions were evaluated during the course of treatment. The local control rate and curative effect of two groups were evaluated 6 months after the completion of treatment. The local control rate, tumor-free survival rate, total survival rate and the cause of treatment failure were observed and followed up. Results Both IMRT and 6 cycles of chemotherapy were completed in both groups, with no cases of follow-up. There was no statistical difference in the incidence of radiodermatitis, mucositis, dysphagia, dry mouth, myelosuppression, gastrointestinal tract reaction and taste disturbance in the two groups (100.0%) in the observation group was significantly higher than that in the control group (82.8%) (P <0.05). The effective rate of the treatment group (100.0%) was significantly higher than that of the control group %, Respectively). The local control rates (100.0%, 100.0%, 85.7%, 75.0%, 60.7%) of the observation group after 1a, 2a, 3a, Were higher than those in the control group (86.2%, 82.8%, 72.4%, 58.6%, 37.9%) (P <0.05). The tumor-free survival rates were higher than those in the control group (100.0%, 92.8%, 78.6%, 67.9%, 57.1% The overall survival rate (100.0%, 96.4%, 85.7%, 78.6%, 64.3%) in the control group (86.2%, 79.3%, 65.5%, 51.7%, 34.5% %, 89.7%, 72.4%, 58.6%, 41.4% respectively) (P <0.05). The total failure rate of the control group (65.5%), local nasopharyngeal recurrent or uncontrollable rate (13.8%), regional lymph node metastasis The rate (34.5%) was higher than that of the observation group (42.9%, 3.5%, 21.4%) (P <0.05). Conclusions Simultaneous chemoradiotherapy combined with ~ (125) I particle implantation in advanced stage nasopharyngeal carcinoma can improve the curative effect, reduce the incidence of distant metastasis, and does not increase adverse reactions.