同期放化疗与尼妥株联合放疗治疗局部晚期鼻咽癌的疗效及毒副反应对比

发布时间：2018-06-10 20:45

本文选题：鼻咽癌 + 同期放化疗　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:比较同期放化疗(CRT)及尼妥株联合放疗(NRT)治疗局部晚期鼻咽癌的远期疗效和毒副反应。方法:收集2010年1月-2012年12月至我院肿瘤科接受治疗的初治局部晚期鼻咽癌患者64例,其中36例接受顺铂联合同期放疗,28例接受尼妥株联合放疗。所有患者放疗前均行DP方案诱导化疗2周期:多西他赛75mg/m2 d1,顺铂35mg/m2 d1-2,每3周为1个疗程。2周期诱导化疗后2-3周行根治性放疗。CRT组:顺铂40mg/m2/w,共6次。NRT组:尼妥株单抗200mg/w,共6次。两组均采用调强放疗技术,处方剂量PGTV-nx:66-70Gy/30F;PGTV-nd:60-70Gy/30F;鼻咽高危亚临床靶区PCTV-60:60Gy/30F;鼻咽低危亚临床靶区PTV-54:54Gy/30F。每日1次,每周5次。结果:远期疗效:CRT组3年总生存率为83.3%,NRT组3年总生存率为82.1%,P=0.868,两组差异无统计学意义;CRT组3年无进展生存率77.8%,NRT组3年无进展生存率为75.0%,P=0.819,两组差异无统计学意义;CRT组3年无局部区域复发率为91.7%,NRT组3年无局部区域复发率为89.3%,P=0.760,两组差异无统计学意义;CRT组3年无远处转移率为86.1%,NRT组3年无远处转移率为85.7%,P=0.947,两组差异无统计学意义。急性毒性反应:III/IV级白细胞减少CRT组为38.9%,NRT组为14.3%,P=0.030,两组差异有统计学意义;III/IV级中性粒细胞减少CRT组为33.3%,NRT组10.7%,P=0.034,两组差异有统计学意义;血小板减少发生率CRT组为5.6%,NRT组为10.7%,P=0.646,两组差异无统计学意义;III/IV级贫血CRT组为16.7%,N-RT组为0,P=0.031,两组差异有统计学意义;I/II级呕吐CRT组为50%,NRT组为25%,P=0.042,两组有统计学意义;III/IV级呕吐CRT组为27.8%,NRT组为0,P=0.003,两组差异有统计学意义。放疗相关急性毒副反应:I/II级口腔黏膜炎CRT组为38.9%,NRT组为42.9%,P=0.621,两组差异无统计学依依;I/II级皮肤反应CRT组为36.1%,NRT组为39.3%,P=0.795,两组差异无统计学意义;III/IV级皮肤反应CRT组为25.0%,NRT组为25%,P=1.000,两组差异无统计学意义;III/IV反应级口腔黏膜炎CRT组为33.3%,NRT组为28.6%,P=0.683,两组差异无统计学意义。放疗相关晚期毒性:I-IV级放射性脊髓病两组均未出现;I/II级放射性脑病发生率CRT组为5.6%,NRT组为3.6%,P=0.709,两组差异无统计学意义;III/IV放射性脑病两组均未出现;I/II级放射性放射性组织纤维化发生率CRT组为8.3%,NRT组为3.6%,P=0.435,两组差异无统计学意义;III/IV级放射性纤维组织化两组均未出现;I/II级唾液腺放射损伤CRT组为77.8%,NRT组为82.1%,P=0.667,两组差异无统计学意义;III/IV唾液腺损伤两组均未出现;I/II级耳部放射损伤CRT组为22.2%,NRT组为21.4%,P=0.939,两组差异无统计学意义;III/IV级耳部放射性损伤两组均未出现。具体见表3.4。结论:CRT组与NRT组对局部晚期鼻咽癌患者远期疗效相似;毒副反应方面:CRT组III/IV级白细胞减少、III/IV级中性粒细胞减少、III/IV级贫血、I-IV级呕吐反应明显高于NRT组,差异具有统计学意义;两组放疗相关急性毒副反应和晚期损伤无统计学意义。
[Abstract]:Objective: to compare the long term effects and side effects of CRT and NRTT in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Methods: from January 2010 to December 2012, 64 patients with locally advanced nasopharyngeal carcinoma were treated from January 2010 to December 2012 in our hospital. Among them, 36 cases received cisplatin combined with concurrent radiotherapy and 28 cases received nitrite strain combined radiotherapy. All patients were treated with DP regimen induction chemotherapy for 2 cycles before radiotherapy: docetaxel 75mg/m2 D1, cisplatin 35mg/m2 d1-2, radical radiotherapy / CRT group: cisplatin 40 mg / m ~ 2 / w, n = 6 times 路NRT group: nitrite McAb 200mg / w, every 3 weeks for 2 to 3 weeks after induction chemotherapy. Both groups were treated with intensity-modulated radiotherapy. The prescription dose of PGTV-nx: 66-70Gy / 30FN PGTV-ndw 60-70Gy / 30F; the high risk subclinical target of nasopharynx, PCTV-60: 60Gy / 30F; and the subclinical target area of low risk of nasopharynx, PTV-54 / 54Gy / 30F. Once a day, 5 times a week. Results: the 3 year overall survival rate of the 7: 8% CRT group was 83.3%. The 3-year overall survival rate of the NRT group was 82.1%. There was no significant difference between the two groups. There was no significant difference between the two groups in the 3-year progressive free survival rate (77.8%) in the NRT group, and there was no significant difference between the two groups in the 3-year progression-free survival rate (75.0%). There was no significant difference between the two groups. The 3-year non-local recurrence rate was 91.7% in the NRT group and 89.3% in the CRT group. There was no significant difference between the two groups. The non-distant metastasis rate in the CRT group was 86.1% and the non-distant metastasis rate in the NRT group was 85.7%. There was no significant difference between the two groups. Acute toxic reaction: grade III / IV leukopenia in CRT group was 38.9% and that in NRT group was 14.3i / Pn.0.030, and the difference between the two groups was statistically significant: 33.3i / IV grade neutropenia CRT group was 33.3i / IV grade CRT group (10.7%), and the difference between the two groups was statistically significant (P < 0.05). The incidence of thrombocytopenia in CRT group was 10.7 / 0.646, and there was no significant difference between the two groups. There was no significant difference between the two groups. In the CRT group of grade III / IV anemia, it was 16.7and 0.031 in N-RT group, and the difference between the two groups was statistically significant. The difference between the two groups was statistically significant: 50 P0.042 in 50 NRT group. There was statistical significance between the two groups in grade III- IV vomiting CRT. The difference between the two groups was statistically significant. There was no significant difference between the two groups (38.9%) and NRT group (42.9% P0.621), and there was no significant difference between the two groups. The difference between the two groups was 36.1% (P 0.795), and there was no significant difference between the two groups. The difference between the two groups was 25.0% and 25.0% (P = 1.000), and the difference between the two groups was significant (P < 0.05), but the difference between the two groups was not significant (P < 0.05), but the difference between the two groups was not statistically significant (P < 0.05), but the difference between the two groups was not statistically significant (P < 0.05), but the difference between the two groups was not statistically significant (P < 0.05). There was no significant difference between the two groups. There was no significant difference between the two groups. There was no significant difference between the two groups. The CRT group was 33.3and the NRT group was 28.60.683. there was no significant difference between the two groups. The incidence of radiation associated advanced toxicity I-IV radiation encephalopathy in the CRT group was 5.6%, and the incidence of radiation encephalopathy in the CRT group was 3.6%. 709 in the CRT group. There was no significant difference between the two groups. There was no significant difference between the two groups in the incidence of radiation encephalopathy of grade I / II. There was no significant difference between the two groups in the incidence of radiation encephalopathy of grade I / II. The incidence of fibrous fibrosis in CRT group was 8.3g / NRT 3.60.35. there was no significant difference between the two groups. There was no significant difference between the two groups. There was no significant difference between the two groups. There was no significant difference between the two groups in the incidence of radiation injury of salivary glands of grade I / II in CRT group and in the CRT group (P = 82.66), and there was no significant difference between the two groups in terms of salivary glands of III / IV in CRT group and 77.8% in NRT group (P = 0.667). No I / II grade radiation injury was found in the two groups. In CRT group, 22.2% NRT was 21.4% P0. 939. There was no significant difference between the two groups. There was no significant difference between the two groups in grade III / IV radiation injury. See table 3.4 for details. Conclusion the long term curative effect of the two groups is similar to that of the NRT group, and the side effects of the two groups are significantly higher than that of the NRT group in the grade III / IV neutropenia and grade III / IV anemia, and the difference is statistically significant. There was no significant difference in radiation associated acute side effects and late injury between the two groups.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.63

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