奈达铂同期调强放疗联合化疗治疗晚期鼻咽癌

Cocurrent Nedaplatin Chemoradiotherapy Plus Adjuvant Chemotherapy and Intensity Modulated Radiotherapy for Locally Advanced Nasopharyngeal Carcinoma

摘要:

目的: 观察奈达铂同期调强放射治疗联合辅助化疗对局部晚期鼻咽癌的临床疗效和毒副反应。 方法: 初治局部晚期鼻咽癌患者60例,按1992年福州分期Ⅲ期40例,Ⅳ期20例。鼻咽和全颈、锁上靶体积均采用全程IMRT技术照射,鼻咽肿瘤(PTV)和颈部转移淋巴结(PTVnd)处方剂量为69.96 Gy,鼻咽区域及上颈部临床靶区(PTV1)处方剂量为60.06 Gy,下颈部锁骨上区域(PTV2)处方剂量为50.96 Gy。腮腺50%体积≤35 Gy,晶体、垂体、颞颌关节、下颌骨及颞叶的最高限量分别为9,54,60,0,60 Gy,脑干、脊髓、视神经、视交叉的计划危及器官区(planning organ at risk volume,PRV)1%体积最高限量分别为54,40,54,54 Gy。按EORTC或RTOG标准评价急性反应。全组患者均给与同期化疗,放疗结束予3周期辅助化疗。 结果: 中位随访56个月,1,2,3,4年局部控制率100%(60/60),98.33%(59/60),93.3%(56/60),90.0%(54/60);1,2年总生存率(OS) 均为98.33%,3,4年总生存率(OS)分别为 90.00%(54/60),85.0%(51/60),1,2,3,4年无远处转移生存率96.67%(58/60),93.33%(56/60),86.7%(52/60),80.0%(48/60)。 结论: 局部晚期鼻咽癌奈达铂同期调强放化疗联合辅助化疗可获得较理想的局部区域控制率和总生存率,3~4级急性黏膜炎和血液学毒性是化疗的剂量限制性因素。

Abstract:

Objective: The aim of this study are to evaluate the clinical effect and toxicities of cocurrent nedaplatin chemoradiotherapy with intensity modulated radiotherapy (IMRT)plus adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma. Method: A total of 60 patients with locally advanced nasopharyngeal carcinoma(according to Fuzhou 92 staging system)were enrolled into this study,40 patients had stage Ⅲ lesion while 20 patients had stage Ⅳa lesion.The regions of nasopharynx and upper and lower neck were all irradiated by IMRT technique. The prescribed dose 69.96 Gy was delivered to the gross tumor volume (PTV) and positive neck nodes (PTVnd); 59.36 Gy to the clinical target volume (PTV1), covering the upper neck and area around the nasopharynx; and 50.96 Gy to the low neck and supraclavicular area (PTV2). The dose to 50% of the parotid was ≤35 Gy. The maximum dose to the lens, pituitary gland, temporo-mandibular joint, mandible, and temporal lobe was 9, 54, 60, 70, 60 Gy. The maximum dose to the brain stem, spinal cord, optic nerve and optic chiasma (PRV) was 54, 40, 54, 54 Gy, respectively.Acute toxicities were evaluated according to EORTC/RTOG radiation morbidity scoring criteria.All patients received concurre chemoradiotherapy before three cycles of adjuvant chemotherapy. Result: With a median follow-up of 56 months,the 1,2,3,4-year locoregional control rate was 100% and 98.33%,93.3%,90.0%, the 1,2,3,4-year overall survival and distant metastasis free survival were 98.33%,98.33%,90.00%,85.0%and 96.67%,93.33%,86.7%,80.0%respectively. Conclusion: Cocurrent chemoradiotherapy with IMRT plus adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma is feasible,grade 3 to 4 mucositis and grade 3 to 4 hematologic toxicity are considered to be limiting factors of chemoradiotherapy and influence the quality of life.It may be able to improve the locoregional control rate and overall survival for locally advanced nasopharyngeal carcinoma and be worthy of further clinical investigation.