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目的:研究后程加速超分割放疗联合化疗治疗Ⅲ、Ⅳa期鼻咽癌的疗效。方法:将100例Ⅲ、Ⅳa期鼻咽癌随机分为后程加速超分割放疗联合化疗组及常规分割放疗联合化疗组。后程加速超分割放疗联合化疗组于放疗前先行诱导化疗2次;化疗后先行常规分割放疗至鼻咽部剂量为40Gy,缩野后行后程加速超分割放疗至鼻咽部总剂量为70Gy;于放疗结束后再行辅助化疗2次。常规分割放疗联合化疗组化疗方法与后程加速超分割放疗联合化疗组相同;放疗采用常规分割,鼻咽部总剂量为70Gy。结果:后程加速超分割放疗联合化疗组及常规分割放疗联合化疗组的2年实际生存率分别为83.6%及79.7%(P>0.05);2年无瘤生存率分别为76.5%及59.1%(P<0.05);2年局部区域无复发生存率分别为90.0%及69.7%(P<0.05)。后程加速超分割放疗联合化疗组有2例出现放射性后组脑神经损伤,常规分割放疗联合化疗组无严重后期并发症。结论:后程加速超分割放疗联合化疗较常规分割放疗联合化疗提高了Ⅲ、Ⅳa期鼻咽癌的2年局部区域无复发生存率及2年无瘤生存率,但增加了后期并发症的发生率,其长期疗效及后期不良反应有待进一步随访观察。
Objective: To study the effect of late-course accelerated hyperfraction radiotherapy and chemotherapy on stage Ⅲ and Ⅳa nasopharyngeal carcinoma. Methods: One hundred cases of stage Ⅲa and Ⅳa nasopharyngeal carcinoma were randomly divided into late accelerated hyperfractionated radiotherapy combined with chemotherapy and conventional radiotherapy combined with chemotherapy. Radiation-induced hyperfractionated radiotherapy plus chemotherapy led to chemotherapy two times prior to radiotherapy. Radiotherapy followed by conventional radiotherapy to nasopharyngeal dose of 40 Gy, followed by accelerated radiofrequency hyperfraction radiotherapy to nasopharyngeal total dose of 70 Gy ; Radiotherapy after the adjuvant chemotherapy 2 times. Conventional radiotherapy combined with radiotherapy combined with chemotherapy chemotherapy and the latter accelerated hyperfractionated radiotherapy combined with chemotherapy; radiotherapy using conventional segmentation, the total dose of nasopharyngeal 70Gy. Results: The 2-year actual survival rates were 83.6% and 79.7% respectively (P> 0.05). The 2-year disease-free survival rates were 76.5% and 59.1%, respectively (P <0.05). The two-year local recurrence-free survival rates were 90.0% and 69.7%, respectively (P <0.05). There were 2 cases of postoperative radioactive cranial nerve injury in the late accelerated hyperfraction radiotherapy combined with chemotherapy group and no severe late complications in the conventional radiotherapy combined with chemotherapy group. Conclusions: Late-course accelerated hyperfraction radiotherapy combined with chemotherapy improves radiotherapy-free survival and 2-year disease-free survival rate in stage IIa and IVa nasopharyngeal carcinoma compared with conventional radiotherapy combined with chemotherapy, but increases the incidence of late complications Rate, its long-term efficacy and adverse reactions to be further follow-up observation.