晚期喉癌术后同步放化疗与单纯放疗临床疗效的比较

发布时间：2018-06-24 11:44

本文选题：晚期喉癌 + 放射治疗　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：背景与目的:晚期喉癌(Ⅲ~Ⅳ期)的恶性程度较高,容易出现局部复发及远处转移,预后往往较差。本文对蚌埠医学院第一附属医院肿瘤放疗科的64例晚期术后喉癌进行回顾性分析,旨在探讨术后同步放化疗与术后单纯放疗两种治疗方案在晚期喉癌治疗中的临床疗效差异并总结复发和死亡情况,分析影响晚期喉癌生存及预后相关的因素。方法:回顾性分析蚌埠医学院第一附属医院肿瘤放疗科2012年1月至2013年12月收治的64例晚期喉癌术后患者的临床资料,其中Ⅲ期30例,Ⅳ期34例;声门上型29例,声门型32例,声门下型3例。33例晚期喉癌患者术后接受放疗联合以铂类为基础的同步化疗(同步放化疗组),其中行全喉切除术者21例,行保喉手术者12例;手术后仅行单纯放疗31例(单纯放疗组),其中全喉切除者17例,保喉者14例。随访结束后,有3例患者失访,其中同步放化疗组2例,单纯放疗组1例,随访率95.31%。使用SPSS17.0统计软件进行数据分析,运用Kaplan-meier法进行生存分析,Log-rank法进行检验,并对预后因素行单因素分析,应用Cox比例风险模型行多因素分析。结果:64例患者3年累积生存率为60.9%。同步放化疗组和单纯放疗组3年生存率分别为77.7%和50.5%,两组生存率差异有统计学意义(P0.05);两组Ⅲ~Ⅳ级不良反应中放射性黏膜反应及骨髓抑制发生率差异均无统计学意义(P0.05),仅Ⅲ~Ⅳ级胃肠道不良反应发生率差异有统计学意义(P0.05),认为化疗的应用可增加患者胃肠道反应的发生率。全喉切除者与保喉者3年生存率分别为73.1%和54.2%,对术式不同水平进行检验,差异无统计学意义(P0.05)。64例患者中34例出现复发,总复发率为53.13%。其中同步放化疗组11例患者复发,包括原发灶复发1例,颈部复发9例,远处转移1例,复发率为33.33%;单纯放疗组23例患者复发,包括原发灶复发2例,颈部复发18例,远处转移3例,复发率为74.19%。64例患者中25例死亡,总死亡率为39.06%。死亡原因主要包括:肿瘤原发灶复发2例,颈部复发21例,远处转移2例。其中同步放化疗组死亡7例,死亡率为21.21%;单纯放疗组18例,死亡率为58.06%。单因素分析结果显示:年龄、肿瘤分型、术后治疗方案,有无淋巴结转移是影响患者生存预后的因素;Cox回归分析显示:年龄、术后治疗方案、有无淋巴结转移是影响预后的独立因素。结论:晚期喉癌术后同步放化疗3年生存率高于术后单纯放疗,且不会明显增加Ⅲ~Ⅳ级不良反应。晚期喉癌的治疗仍主要为手术切除,全喉切除术与保喉手术对患者3年生存率影响无明显差异,可在严格掌握手术适应症的基础上尽可能选择保留喉功能的手术。同时随访过程中,若发现局部复发,需及时实行挽救性全喉切除术;晚期喉癌颈部淋巴结复发率较高,且为治疗失败及死亡的主因之一,因此对于术前发现颈部淋巴结转移的喉癌患者,及时处理有望提高生存率;年龄、术后治疗方案、有无淋巴结转移是影响本研究晚期喉癌预后的独立因素。
[Abstract]:Background and objective: the malignant degree of advanced laryngocarcinoma (stage III ~ IV) is higher and prone to local recurrence and distant metastasis, and the prognosis is often poor. A retrospective analysis of 64 cases of late postoperative larynx cancer in the tumor radiotherapy department of the First Affiliated Hospital of Bengbu Medical College was reviewed in this paper. The purpose of this study was to explore the two treatment schemes of postoperative concurrent chemoradiotherapy and postoperative radiotherapy alone. In the treatment of late larynx, the difference in the clinical efficacy and the recurrence and death were summarized, and the factors affecting the survival and prognosis of advanced laryngocarcinoma were analyzed. Methods: a retrospective analysis of the clinical data of 64 patients with advanced laryngeal cancer from January 2012 to December 2013 of the First Affiliated Hospital of Bengbu Medical College, including 30 cases in stage III, was analyzed. There were 34 cases in stage IV, 29 cases with supra glottis, 32 cases of glottic type, 3 cases of.33 patients with advanced laryngectomy combined with platinum based synchronous chemotherapy (synchronous radiotherapy and chemotherapy group) after operation, including 21 cases of total laryngectomy and 12 cases of laryngectomy. Only 31 cases of single pure radiotherapy (simple radiotherapy group), and 17 cases of total laryngectomy, were performed after operation. There were 14 cases of larynx. After the follow-up, 3 patients were lost, including 2 cases in concurrent chemo chemotherapy group and 1 cases in simple radiotherapy group. The follow-up rate was 95.31%. using SPSS17.0 software for data analysis. Kaplan-meier method was used to carry out survival analysis, Log-rank method was used to test, and the prognostic factor was analyzed by single factor analysis, and Cox proportional risk model was used for multiple causes. Results: the cumulative 3 year survival rate of the 64 patients was 77.7% and 50.5% in the 60.9%. synchronous radiotherapy group and the radiotherapy group, respectively. The survival rates of the two groups were statistically significant (P0.05), and there was no significant difference between the two groups of grade III ~ IV adverse reactions (P0.05), only grade III to IV The difference in the incidence of gastrointestinal tract adverse reactions was statistically significant (P0.05). It was considered that the use of chemotherapy could increase the incidence of gastrointestinal reactions in patients. The 3 year survival rate of total laryngectomy and laryngectomy was 73.1% and 54.2%, respectively, and the difference was not statistically significant (P0.05) in.64 patients with recurrence and total recurrence rate. There were 11 cases of recurrent chemotherapy in 53.13%., including 1 cases of primary recurrence, 9 cases of cervical recurrence, 1 cases of distant metastasis and 33.33% recurrence rate. 23 cases had recurrence in simple radiotherapy group, including 2 cases of primary recurrence, 18 cases of cervical recurrence, 3 cases of distant metastasis, and 25 cases of death in 74.19%.64 cases, the total mortality was 39.06%. death. The main reasons include: 2 cases of primary tumor recurrence, 21 cases of cervical recurrence and 2 cases of distant metastasis, of which 7 cases died in synchronous radiotherapy and chemotherapy group, the mortality rate was 21.21%, and 18 cases in simple radiotherapy group, the death rate of 58.06%. single factor analysis showed that age, tumor typing, postoperative treatment, lymph node metastasis were factors affecting the survival prognosis of the patients. Cox regression analysis showed that age, postoperative treatment scheme and lymph node metastasis were independent factors affecting prognosis. Conclusion: the 3 year survival rate of postoperative concurrent chemoradiotherapy for advanced laryngectomy is higher than that of postoperative radiotherapy alone, and there is no obvious increase of grade III to IV adverse reactions. The treatment of advanced laryngectomy is still mainly surgical resection, total laryngectomy and laryngectomy. There is no significant difference in the 3 year survival rate of the patients. In the course of follow-up, salvage total laryngectomy is necessary and the recurrence rate of cervical lymph nodes in late laryngectomy is high and it is one of the main causes of failure and death in the late stage of laryngectomy. Therefore, for patients with cervical lymph node metastasis before operation, the survival rate is expected to be improved in time. Age, postoperative treatment and lymph node metastasis are independent factors that affect the prognosis of late larynx cancer.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.65

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