局部中晚期鼻咽癌动脉灌注化疗联合调强同步放疗的毒副反应及近期临床疗效分析

发布时间：2018-05-05 02:44

本文选题：局部中晚期鼻咽癌 + 动脉灌注　；参考：《大连医科大学》2010年硕士论文

【摘要】： 目的：明确动脉灌注同步化疗联合调强放射治疗在局部中晚期鼻咽癌(nasopharyngeal carcinoma, NPC)治疗中的价值。方法：采用前瞻性随机对照研究,把病理确诊的36例局部中晚期(Ⅱ-Ⅳa期)初治鼻咽癌患者在治疗前随机分成两组。1 9例患者经颈外动脉进行区域性动脉灌注同步放化疗(实验组),化疗方案为“PF”方案,即放疗前5天开始DDP 60 mg/m2供血动脉插管灌注,5-FU 1.0g/m2供血动脉插管灌注,区域动脉灌注后5天即进行放射治疗,放疗进行四周后进行第二次动脉灌注化疗。17例患者进行全身静脉化学治疗(对照组),化疗方案为“PF”方案,DDP 40 mg/m2第1～5天；5-FU 500 mg/m2第1～5天,化疗方案完成1天后开始放疗,放疗进行四周后进行第二次全身化疗。放疗方案为调强放射治疗(intensity modulated radiation therapy IMRT), CT模拟定位机,行颅底骨至锁骨下区层厚3mmCT增强扫描,将图像通过局域网传到飞利浦Pinnacle调强放射计划系统。勾画靶区：肿瘤靶区(GTV)根据临床检查、CT、MRI及PET—CT等影像检查确定的肿瘤病灶,包括原发肿瘤、咽旁以及颈部的转移淋巴结,考虑摆位误差外放3mm；临床靶区(CTV)包括鼻咽壁、咽后及咽侧间隙、下组筛窦、翼腭窝、颅底、后1／3鼻腔、上颌窦及颈部深淋巴结。鼻咽肿瘤区和肿大淋巴结区为GTVnx、GTVnd,高危亚临床区和低危亚临床区CTV1和CTV2,GTV、CTV1和CTV2的平均照射剂量分别达到了71.74Gy、68.84Gy、64.33Gy,平均分次剂量达到了2.04Gy以上。对比治疗后的毒性反应和近期疗效。统计学方法采用χ2检验。结果：1.毒副反应：在36例中晚期鼻咽癌的治疗中,大部分患者都出现了放疗、化疗毒副反应,但轻重不一。主要表现有口腔粘膜反应、口腔溃疡和口干无味;胃肠道反应如恶心、呕吐和纳差；放射部位皮肤干湿性皮炎；白细胞减少、血小板减少、静脉炎等,肝肾功能无明显损害。从(表2)可以看出,口腔粘膜反应、腮腺炎和血小板减少在实验组和对照组无明显差异,P0.05.白细胞减少和胃肠道反应的情况在两组有明显差异,P0.05。2.近期疗效：所有病例均在放疗结束后3个月、6个月、1年评定疗效,实验组3个月CR 5例,PR 14例,NC 0例,PD 0例；6个月CR 7例,PR 12例,NC 0例,PD 0例：1年CR 8例,PR 9例,NC 1例,PD 1例；3个月总缓解率(CR+PR)为100%(19／19)；6个月总缓解率(CR+PR)为100%(19／19)；1年总缓解率(CR+PR)为89.5%(17／19)。对照组3个月CR 3例,PR 13例,NC 2例,PD0例；6个月CR 5例,PR 10例,NC 3例,PD 0例；1年CR 6例,PR 7例,NC 2例,PD 2例；3个月总缓解率(CR+PR)为94.1%(16／1 7)；6个月总缓解率(CR+PR)为88.2%(15／17)；1年总缓解率(CR+PR)为76.5%(13／17)。用χ2检验,P0.05,两者比较差异有统计学意义。结论：经颈外动脉灌注同步放化疗能减少全身用药剂量,同时增加局部药物浓度,减轻化疗药物对患者的毒性反应。同时明显降低远处转移提高患者的生存质量和提高生存率。对颈外动脉灌注同步化放疗治疗中晚期鼻咽癌疗效明显优于全身同步化疗及放疗治疗中晚期鼻咽癌。
[Abstract]:Objective : To evaluate the value of intra - arterial perfusion synchronous chemotherapy combined with radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma ( NPC ) .

Methods : Thirty - six patients with nasopharyngeal carcinoma ( NPC ) were randomly divided into two groups before treatment with a prospective randomized controlled study .
5 - FU 500 mg / m 2 days 1 - 5 , after the chemotherapy regimen was completed for 1 day , radiotherapy was started , and the second systemic chemotherapy was carried out after radiotherapy . The radiotherapy regimen consisted of intensity modulated radiation therapy IMRT , CT simulated positioning machine , skull base bone to subclavian region layer thickness 3mmCT enhanced scanning .
The mean irradiation doses of CTV1 and CTV2 , GTV , CTV1 and CTV2 were 71.74Gy , 68.84Gy , 64.33Gy , respectively . The average doses of CTV1 and CTV2 , GTV , CTV1 and CTV2 in the nasopharyngeal tumor area and the enlarged lymph node area were 71.74Gy , 68.84Gy , 64.33Gy , respectively .

Results : 1 . Toxic side reaction : In the treatment of 36 patients with advanced nasopharyngeal carcinoma , most of the patients had radiotherapy and chemotherapy toxicity , but the severity was different . The main manifestations were oral mucosa reaction , oral ulcer and dry mouth , and gastrointestinal reactions such as nausea , vomiting and anorexia .
Radiation site skin dry and wet dermatitis ;
There was no significant difference in the function of liver and kidney between the experimental group and the control group ( P < 0.05 ) . The results showed that there were no significant difference between the experimental group and the control group , P < 0.05 . 2 . Short term effect : All cases were evaluated in 3 months , 6 months and 1 year after radiotherapy .
6 months CR 7 cases , PR 12 cases , NC 0 cases , PD 0 cases : 1 year CR 8 cases , PR 9 cases , NC 1 case , PD 1 case ;
The total response rate ( CR + PR ) was 100 % ( 19 / 19 ) in 3 months .
The total response rate ( CR + PR ) of 6 months was 100 % ( 19 / 19 ) .
1 - year response rate ( CR + PR ) was 89.5 % ( 17 / 19 ) . The control group was 3 months CR 3 , PR 13 , NC 2 , PD0 .
6 months CR 5 cases , PR 10 cases , NC 3 cases , PD 0 cases ;
1 year CR 6 cases , PR 7 cases , NC 2 cases , PD 2 cases ;
The total response rate ( CR + PR ) was 94.1 % ( 16 / 17 ) in 3 months .
The total response rate ( CR + PR ) was 88.2 % ( 15 / 17 ) in 6 months .
The total response rate ( CR + PR ) was 76.5 % ( 13 / 17 ) in 1 year .

Conclusion : Combined chemotherapy with external carotid artery perfusion can reduce systemic dosage , increase local drug concentration , reduce the toxicity of chemotherapeutic drugs to patients , and decrease the distant metastasis to improve the survival quality and survival rate of patients .

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63

【参考文献】