鼻咽癌放化疗综合模式及治疗后复发挽救性治疗的系列研究

发布时间：2018-05-09 21:09

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

【摘要】：第一部分新辅助化疗联合同步放化疗对比单纯同步放化疗治疗鼻咽癌的远期疗效观察目的新辅助化疗+同步化疗能否改善鼻咽癌患者生存预后仍存在争议。本研究旨在研究新辅助化疗在鼻咽癌治疗中的作用。方法对我院2006.12-2012.12共255例经病理确诊、初治无远处转移、接受了新辅助化疗联合同步放化疗或单纯同步放化疗的鼻咽癌患者进行回顾性研究,放疗技术均为调强放疗。其中,接受新辅助化疗+同步化疗组(NCT组)67例,单纯同步化疗组(CRT组)188例。为控制组间不平衡及混杂偏倚,以年龄、性别、KPS评分、T-、N-及临床分期、WHO分型、同步化疗方案8个变量建模,使用倾向性得分匹配对其进行1:2配对,成功配对后新辅助化疗组(NCT组)67例,单纯同步化疗组(CRT组)134例,对成功匹配后两组病例的远期疗效及毒性反应等进行对比研究分析。结果本研究新辅助化疗组(NCT组)中位随访时间49月(11~105月),单纯同步化疗组(CRT组)为48月(8~109月)。NCT组、CRT组5年总生存率(OS)分别为78.8%vs.79.5%(p=0.305);5年无进展生存率(PFS)分别为69.1%vs 75.7%(p=0.448),5年无复发生存率(RFS)分别为90.0%vs.92.7%(p=0.790),5年无局部复发生存率(LRFS)分别为90.0%vs.94.2%(p=0.512),5年无区域复发生存率(RRFS)分别为100%vs.96.1%(p=0.104),5年无远处转移生存率(DFFS)分别为78.3%vs.82.7%(p=0.671)。全组病例多因素分析结果示治疗方式(NCT vs.CRT)对OS、PFS、RFS、LRFS、RRFS及DFFS无明显差别(p=0.627、0.879,0.760,0.847,0.969及0.774);全组接受同步化疗≥2周期者获得更好的OS、RFS及DFFS(p=0.009、0.016及0.043)。本研究中PF或TPF对比其他不同新辅助化疗方案并无明显优势(OS、PFS、LRFS及DFFS的p值分别为0.321、0.254、0.380及0.304)。两组间急性和晚期毒副反应发生率无明显差异。结论新辅助联合同步放化疗对比单纯同步放化疗在鼻咽癌治疗中远期疗效相当,其毒性范围可控。新辅助化疗在鼻咽癌治疗中的作用及地位仍需进一步研究。第二部分初治鼻咽癌调强放疗后复发情况及复发因素目的研究鼻咽癌调强放疗后的复发情况,探讨其复发因素。方法回顾性分析我院2006.09-2012.09 720例经病理确诊、初治无远处转移的鼻咽癌根治性IMRT后情况,研究其总生存率(OS)、无进展生存率(PFS)、无复发生存率(RFS)、无局部复发生存率(LRFS)、无区域复发生存率(RRFS)及无远处转移生存率(DFFS),主要分析其复发情况及复发因素。结果全组中位随访时间为53个月(8~109个月)。5年总生存率(OS)、无进展生存率(PFS)、无复发生存率(RFS)、无局部复发生存率(LRFS)、无区域复发生存率(RRFS)及无远处转移生存率(DFFS)分别为79.9%、73.8%、91.4%、93.1%、96.7%及85.8%。全组共60例鼻咽癌放疗后出现复发,其中单纯局部复发36例,单纯区域复发12例,局部+区域复发10例,局部残留复发1例,区域残留复发1例。其中位复发时间为22个月(3-82月)。多因素分析结果显示,年龄为≥44岁为局部复发的危险预后因素(p=0.030),T-、N-、临床分期等均非复发相关因素(p均大于0.05)。结论初治鼻咽癌调强放疗后取得较好的局部区域控制,但仍存在复发失败模式,以3年内复发最为常见。年龄≥44岁为鼻咽癌根治性IMRT后复发危险因素。如何降低鼻咽癌放疗后复发,仍需进一步研究。第三部分调强放疗后复发鼻咽癌挽救性调强放疗的安全性及疗效目的初步评估鼻咽癌调强放疗后复发挽救性IMRT的安全性、可行性及有效性。方法第二部分所述的复发鼻咽癌中,23例于我院接受了调强放疗为主的挽救性治疗,以复发诊断日期为起点,研究其总生存率(OS)、无进展生存率(PFS)及无远处转移生存率(DFFS),初步研究放疗后复发鼻咽癌挽救性调强放疗的疗效及相关并发症。结果鼻咽癌复发后中位随访时间为19个月(2-63月),其1年、2年OS为72.7%、38.2%。本研究中挽救性IMRT的3~4级毒性反应并不常见。1例患者因自身原因完成39.6 Gy放疗量后放弃治疗,最终死亡。结论根治性IMRT后复发鼻咽癌的挽救性IMRT安全性较高,大部分毒副反应可耐受,但远期疗效较差。如何提高挽救性调强放疗疗效,仍需进一步研究。
[Abstract]:The first part of the new adjuvant chemotherapy combined with concurrent chemoradiotherapy compared with simple concurrent chemoradiotherapy in the long term effect of nasopharyngeal carcinoma in the treatment of nasopharyngeal carcinoma. Objective new adjuvant chemotherapy plus synchronous chemotherapy can improve the survival of nasopharyngeal carcinoma patients. The purpose of this study is to study the role of neoadjuvant chemotherapy in nasopharyngeal carcinoma treatment. Method to our hospital 2006.12-2012.12 A total of 255 patients were diagnosed with no distant metastasis, and a retrospective study of nasopharyngeal carcinoma patients received neoadjuvant chemotherapy combined with concurrent chemo chemotherapy or simple concurrent chemoradiotherapy was performed. The radiotherapy techniques were all intensity modulated radiation therapy. Among them, 67 cases were treated with neoadjuvant chemotherapy + synchronous chemotherapy group (group NCT) and 188 cases in group CRT alone (group CRT). Balance and mixed bias, with age, sex, KPS score, T-, N- and clinical staging, WHO typing, synchronized chemotherapy 8 variables modeling, using the tendency score matching to carry out 1:2 pairing, 67 cases in the new adjuvant chemotherapy group (group NCT) after successful pairing, 134 cases in the pure synchronous chemotherapy group (group CRT), and the long-term efficacy and toxicity of the successful matched group of two cases. Results the median follow-up time of the new adjuvant chemotherapy group (group NCT) was 49 months (11~105 months), the simple synchronous chemotherapy group (group CRT) was 48 months (8~109 month).NCT group, and the total 5 year survival rate (OS) in the CRT group was 78.8%vs.79.5% (p=0.305), and the 5 year progression free survival rate (PFS) was 69.1%vs 75.7% (p=0.448), and no recurrence in 5 years. The survival rate (RFS) was 90.0%vs.92.7% (p=0.790), and the 5 year non local recurrence survival rate (LRFS) was 90.0%vs.94.2% (p=0.512). The 5 year regional recurrence survival rate (RRFS) was 100%vs.96.1% (p=0.104) respectively, and the 5 year distant metastasis survival rate (DFFS) was 78.3%vs.82.7% (p=0.671). CRT) there were no significant differences in OS, PFS, RFS, LRFS, RRFS and DFFS (p=0.627,0.879,0.760,0.847,0.969 and 0.774). The whole group received better OS, RFS and DFFS (p=0.009,0.016 and 0.043). .254,0.380 and 0.304). There is no significant difference in the incidence of acute and late toxic and side effects among the two groups. Conclusion the therapeutic effect of neoadjuvant combined radiotherapy and chemotherapy on the treatment of nasopharyngeal carcinoma is comparable and its toxicity range is controllable. The role and status of neoadjuvant chemotherapy in the treatment of nasopharyngeal carcinoma still need to be further studied. The second part of the new adjuvant chemotherapy still needs to be studied. To study the recurrence and recurrence factors of nasopharyngeal carcinoma after intensity modulated radiotherapy in order to study the recurrence of nasopharyngeal carcinoma after intensity modulated radiotherapy, and to discuss the recurrence factors. Methods the total survival rate (OS) and no progression survival rate (PFS) were studied in 720 cases of 2006.09-2012.09 in our hospital after the primary treatment of nasopharyngeal carcinoma without distant metastasis. No recurrence survival rate (RFS), no local recurrence survival (LRFS), no regional recurrence survival (RRFS) and distant metastasis survival (DFFS). The recurrence and recurrence factors were mainly analyzed. Results the total median follow-up time was 53 months (8~109 months),.5 total survival rate (OS), no progression survival (PFS), no recurrent survival (RFS), no local relapse. Occurrence rate (LRFS), regional recurrence survival (RRFS) and distant metastasis survival rate (DFFS) were 79.9%, 73.8%, 91.4%, 93.1%, 96.7% and 85.8%., and 60 cases of nasopharyngeal carcinoma were recurred after radiotherapy, including 36 cases with simple local recurrence, 12 recurrent regional recurrence, 10 local region recurrence, 1 local residual recurrence and 1 recurrence of regional residual. The recurrence time was 22 months (3-82 months). The results of multiple factors analysis showed that age was 44 years old as a risk prognostic factor for local recurrence (p=0.030), T-, N-, and clinical staging were all non recurrent factors (P greater than 0.05). Conclusion a better local regional control was taken after the initial treatment of nasopharyngeal carcinoma by intensity modulated radiotherapy, but the recurrence failure mode still existed. The most common recurrence in 3 years. Age more than 44 years old is a risk factor for recurrent nasopharyngeal carcinoma recurrence after radical IMRT. Further study on how to reduce the recurrence of nasopharyngeal carcinoma after radiotherapy is still needed. The safety and efficacy of salvage modulated radiotherapy for recurrent nasopharyngeal carcinoma after intensity modulated radiotherapy (third) is a preliminary assessment of the recurrence and salvage IMRT safety of nasopharyngeal carcinoma after intensive radiotherapy. Total, feasibility and effectiveness. In the second part of recurrent nasopharyngeal carcinoma, 23 cases of recurrent nasopharyngeal carcinoma were treated with intensity modulated radiation therapy in our hospital. The total survival rate (OS), progression free survival (PFS) and distant metastasis rate (DFFS) were studied at the starting point of the recurrence diagnosis. The preliminary study on the salvage modulation of recurrent nasopharyngeal carcinoma after radiotherapy Results the median follow-up time after recurrent nasopharyngeal carcinoma was 19 months (2-63 months), 1 years and 72.7% for 2 years OS. The 3~4 grade toxicity of salvaged IMRT in this study was not common in.1 patients after 39.6 Gy radiotherapy, and finally died. Conclusion the recurrence of nasopharynx after radical IMRT was found. Conclusion the recurrence of nasopharynx after radical IMRT. The rescue IMRT of cancer is highly safe, most of the side effects can be tolerated, but the long-term effect is poor. How to improve the efficacy of salvage intensity modulated radiation therapy still needs further study.

【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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