多西他赛联合顺铂诱导化疗后三维适形调强放疗同步化疗对局部晚期鼻咽癌的初步疗效分析

陈伙辉　苏木兰　张楚荣　雷海红　周同冲　陈淑萍　江文波

【摘要】 目的：為提高晚期鼻咽癌患者生存期，探究诱导化疗同步三维适形调强放疗，鼻咽癌控制效果。方法：选取2013年1月-2015年1月本院门诊收治的局部晚期鼻咽癌患者100例，按双盲法将所有患者分为A组、B组，每组50例。其中A组单用三维适形调强同步放化疗，B组在三维适形调强放疗前使用多西他赛联合顺铂进行诱导化疗，对患者疾病近期治疗效果进行评估，统计治疗所致不良反应，观察近期18个月内肿瘤控制率与无转移生存率，对患者治疗后生活质量进行评估。结果：B组肿瘤控制率、无转移生存率分别为90.0%、96.0%，A组分别为74.0%、80.0%，B组较A组患者18个月内病灶转移率低、肿瘤控制率效果好（P<0.05）；B组治疗后患者生活质量改善效果优于A组（P<0.05）；A组治疗后肿瘤改善有效率为74.0%，B组为88.0%，A组疾病治疗效果较B组效果差（P<0.05）；A组胃肠道反应、骨髓抑制、肝脏毒性、神经毒性发生率分别为56.0%、40.0%、24.0%、22.0%，B组分别为40.0%、24.0%、10.0%、10.0%，A组较B组治疗期间不良反应多（P<0.05）。结论：临床在治疗局部晚期鼻咽癌患者时，为提高疾病控制率、减少临床不良反应发生率，可使用多西他赛联合顺铂诱导化疗后同步三维适形调强放化疗，患者生存率明显提高。

【关键词】 鼻咽癌； 同步化疗； 疗效； 三维适形调强放疗； 晚期； 多西他赛； 顺铂

Clinical Effect of 3D Conformal Radiotherapy and Intensity-modulated Radiation Therapy in Locally Advanced Nasopharyngeal Carcinoma after Induction Chemotherapy of Docetaxel and Cisplatin/CHEN Huo-hui，SU Mu-lan，ZHANG Chu-rong，et al.//Medical Innovation of China，2017，14（05）：053-056

【Abstract】 Objective：To improve the lifetime and explore the clinical effect of induction chemotherapy，conformal radiotherapy and intensity-modulated radiation therapy in patients with advanced nasopharyngeal carcinoma.Method：A total of 100 patients with locally advanced nasopharyngeal carcinoma treated in our hospital from Jan 2013 to Jan 2015 were selected.Based on the double-blind method，the subjects were divided into two groups，50 cases in each group.Group A received 3D conformal radiotherapy and intensity-modulated radiation therapy.Before 3D conformal radiotherapy and intensity-modulated radiation therapy，group B received induction chemotherapy of Docetaxel and Cisplatin.The clinical effect，adverse reactions，control rate of tumor and non-metastasis survival rate within recent 18 months as well as life quality of two groups were evaluated.Result：The control rate of tumor and non-metastasis survival rate of group B were 90.0% and 96.0%，group A were 74.0% and 80.0%，within recent 18 months，the metastasis rate and control rate of group B were better than those of group A（P<0.05）.After treatment，the life quality of group B was better than that of group A（P<0.05）.After treatment，the clinical effective rate of group A was 74.0%，it was lower than 88.0% of group B（P<0.05）.The incidence rate of adverse reactions like gastrointestinal reaction，bone marrow inhibition，liver toxicity and neurotoxicity of group A were 56.0%，40.0%，24.0% and 22.0%，group B were 40.0%，24.0%，10.0% and 10.0%（P<0.05）.Conclusion：For patients with locally advanced nasopharyngeal carcinoma，the induction chemotherapy of Docetaxel and Cisplatin as well as 3D conformal radiotherapy and intensity-modulated radiation therapy can improve the control rate of tumor，reduce the adverse event rate and increase the survival rate.

【Key words】 Nasopharyngeal carcinoma； Synchronous chemotherapy； Curative effect； Three dimensional conformal intensity modulated radiation therapy； Advanced； Docetaxel； Cisplatin

First-authors address：Zhaoqing NO.2 Peoples Hospital，Zhaoqing 526000，China

doi：10.3969/j.issn.1674-4985.2017.05.013

鼻咽癌是耳鼻咽喉科（肿瘤放疗科）最为常见的肿瘤类型，其中局部鼻咽癌病变部位多在鼻咽腔侧壁、顶部，此病由于其病变部位解剖结构特殊，不仅疾病早期无法诊断，同时不适合使用手术进行治疗。此病多在晚期被诊断且由于无法手术治疗，临床多选择化疗、放疗的治疗方式，其中放疗为首选[1-2]。近年来随着医疗水平的进步，三维适形调强放疗用于疾病治疗，患者5年生产率在60%以上。有学者提出对于晚期疾病患者适用药物进行化疗，能提高疾病控制率、生存率，同时减轻因同步放化疗导致的不良反应[3-4]。本次对2013年

1月-2015年1月本院收治的100例局部晚期鼻咽癌患者，分别以同步放化疗及两个周期诱导化疗后同步放化疗进行治疗，发现后者肿瘤控制较好，现报道如下。……