局部晚期鼻咽癌综合治疗模式的探讨

发布时间：2018-05-04 18:48

本文选题：鼻咽癌 + 调强放疗(IMRT)　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的回顾性分析IMRT同期放化疗对比IMRT同期放化疗+辅助化疗在局部晚期鼻咽癌中的疗效情况,评估两种不用综合治疗模式在局部晚期鼻咽癌治疗中的疗效和毒副反应情况。方法收集2007年1月至2014年12月在广西医科大学附属肿瘤医院放疗科住院并行同步放化疗±辅助化疗鼻咽癌的Ⅱ-Ⅳb期患者797例,全组病人均经病理确诊为鼻咽癌,其中单纯同步放化疗(CCRT组)261例,同步放化疗+辅助化疗(CCRT+AC组)536例,两组资料按1:1匹配后,得出新样本进行生存分析。用Kaplan-Meier法计算总生存率(OS)、无局部复发率(LFFS)、无远处转移率(DMFS),并用Log-rank检验,Cox模型分析预后因素。结果经匹配后,CCRT组与CCRT+AC组分别为261例、261例匹配成功。在入组的522例患者中共死亡32例,其中,CCRT组14例,CCRT+AC组18例;有20例出现复发,其中CCRT组出现6例,CCRT+AC组出现14例;有42例出现转移,CCRT组出现14例,CCRT+AC组出现28例。CCRT组1、2、3年OS率分别为97.9%、96.2%、86.9%;1、2、3年LFFS率分别为100.0%、96.5%、96.5%;1、2、3年DMFS率分别为97.4%、92.8%、89.0%,对比CCRT+AC组1、2、3年OS率分别为99.6%、97.4%、93.8%;1、2、3年LFFS率分别为99.2%、95.6%、93.2%;1、2、3年DMFS率分别为95.3%、91.8%、87.2%。两组比较差异均无统计学意义(χ2=2.072,P=0.150;χ2=0.363,P=0.547;χ2=0.875,P=0.350)。亚组分析结果提示,对于T4的鼻咽癌患者,同步放化疗后加用辅助化疗能显著改善其生存情况(P=0.001)。CCRT组发生3-4级急性胃肠道反应、骨髓抑制、皮肤及口腔黏膜反应的发生率分别为3.1%(8/261)、21.5(56/261)、12.3%(32/261);而CCRT+AC组分别为3.1%(8/261)、26.8(70/261)、11.5%(30/261),两组在毒副反应方面差异无统计学意义(P=1.000,P=0.152,P=0.787)。结论局部晚期鼻咽癌接受同步放化疗后加用辅助化疗对总生存率、无局部复发率及无远处转移率的提高不明显。但对于T4期鼻咽癌患者有可能可改善其总生存率,但需要更长的随访时间及更多的研究来验证。辅助化疗应用于局部晚期鼻咽癌是安全且能耐受的。目的回顾性的对比局部晚期鼻咽癌患者IMRT联合化疗±靶向治疗的疗效与其不良反应,初步评价在放化疗基础上加用靶向药物的必要性。方法收集2007—2014年间接受IMRT联合同步化疗±辅助化疗加靶向治疗的Ⅲ—Ⅳb期鼻咽癌患者42例(试验组),同期仅行IMRT联合同步放化疗±辅助化疗的患者与其按1∶4配对入组168例(对照组)。Kaplan-Meie r法计算生存率并Logrank检验差异,余用χ2检验。结果随访率为100%,试验组、对照组3年样本量分别为42例、168例。试验组3年OS、LRFS、DMFS率分别为94%、100%、92%,对照组的分别为87.3%、94.6%、89.1%(P=0.647、0.193、0.744)。3—4级胃肠道不良反应、骨髓抑制及口腔黏膜反应发生率试验组分别为7%(3/42)、26%(11/42)、41%(17/42),对照组分别为3.6%(6/168)、17.3%(29/168)、14.9%(25/168)(P=0.388、0.272、0.000)。结论初步结果提示IMRT联合化疗的基础上加用靶向治疗对提高局部晚期鼻咽癌患者OS、LFFS及DMFS的疗效不明显,且有可能加重放化疗相关的口腔黏膜反应。
[Abstract]:Objective a retrospective analysis of IMRT concurrent chemoradiotherapy compared with IMRT concurrent chemoradiotherapy and adjuvant chemotherapy in local advanced nasopharyngeal carcinoma, and to evaluate the efficacy and toxic side effects of two non comprehensive treatment modes in the treatment of locally advanced nasopharyngeal carcinoma. Methods collected from January 2007 to December 2014 at the Affiliated Cancer Hospital of Guangxi Medical University. 797 patients with phase II IV B of nasopharyngeal carcinoma in the radiotherapy department were hospitalized in the radiotherapy department. All the patients were diagnosed as nasopharyngeal carcinoma by pathological diagnosis, including 261 cases of synchronous radiotherapy and chemotherapy (group CCRT), 536 cases with concurrent chemo chemotherapy plus adjuvant chemotherapy (group CCRT+AC). The two groups of data were matched by 1:1, and the survival analysis was obtained by the new sample. Kaplan-Meier method was used. The total survival rate (OS) was calculated, no local recurrence rate (LFFS), no distant metastasis rate (DMFS), and Log-rank test and Cox model were used to analyze the prognostic factors. After matching, 261 cases were matched successfully in group CCRT and CCRT+AC, and 522 patients died in the group, including 14 cases in CCRT group, 18 in CCRT+AC group, and 20 cases recurred. There were 6 cases in group CCRT, 14 in group CCRT+AC, 42 in group CCRT, 14 in group CCRT, 97.9% in group.CCRT in group CCRT+AC, 96.2% and 86.9%, respectively, 100%, 96.5%, 96.5%, respectively, 1,2,3 year DMFS rate respectively, 97.4%, 92.8%, 89%, respectively. The annual LFFS rate was 99.2%, 95.6%, 93.2%, and the rate of DMFS in 1,2,3 was 95.3%, 91.8%, and 87.2%. two, respectively (x 2=2.072, P=0.150; X 2=0.363, P=0.547; X 2=0.875, P=0.350). The subgroup analysis showed that adjuvant chemotherapy after concurrent chemo chemotherapy could significantly improve the survival (P=0.00) for T4 nasopharyngeal carcinoma (P=0.00). 1) the incidence of grade 3-4 acute gastrointestinal tract reaction in.CCRT group was 3.1% (8/261), 21.5 (56/261), 12.3% (32/261), while CCRT+AC group was 3.1% (8/261), 26.8 (70/261), 11.5% (30/261), and there was no statistical difference between the two groups (P=1.000, P=0.152, P=0.787). The total survival rate, no local recurrence rate and no distant metastasis rate are not significantly increased with adjuvant chemotherapy after concurrent chemoradiotherapy, but it is possible to improve the total survival rate for patients with T4 nasopharyngeal carcinoma, but need longer follow-up time and more research to verify. Objective a retrospective comparison of the efficacy and adverse reactions of IMRT combined with chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC), and the necessity of using targeted drugs on the basis of radiotherapy and chemotherapy. Methods to collect the nose of stage III to IV B with IMRT combined chemotherapy plus chemotherapy plus chemotherapy plus targeted therapy for 2007 to 2014. 42 cases of pharynx cancer (test group), the patients with only IMRT combined chemotherapy plus chemotherapy plus chemotherapy and adjuvant chemotherapy were compared with the 1: 4 pairs (control group) 168 cases (control group) and the.Kaplan-Meie R method was used to calculate the survival rate and the difference of Logrank test. The residual rate was 100%, the test group was 42 and 168, respectively, and the experimental group was 3 years OS, LRF. S, the rate of DMFS was 94%, 100%, 92% respectively. The control group was 87.3%, 94.6%, 89.1% (P=0.647,0.193,0.744).3 - 4 gastrointestinal adverse reactions, and the incidence of bone marrow suppression and oral mucosa reaction was 7% (3/42), 26% (11/42), 41% (17/42), and the control group was 3.6% (6/168), 17.3% (29/168), 14.9% (25/168) (P=0.388,0.272,0.000). The preliminary results suggest that the therapeutic effect of IMRT combined with targeted therapy on the improvement of OS, LFFS and DMFS in patients with locally advanced nasopharyngeal carcinoma is not obvious, and it is possible to replay the oral mucosal response related to the replay of chemotherapy.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.63

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