CAJ | 학술논문

目的评价吉西他滨和顺铂与调强放疗序贯治疗局部晚期鼻咽癌的疗效和不良反应.方法 71例局部晚期鼻咽癌(Ⅲ期41例、ⅣA期30例)患者接受新辅助化疗、调强放疗、辅助化疗,新辅助化疗、辅助化疗各2个疗程[吉西他滨1000 mg/m2,第1、8天静脉滴注(＞ 30 min)；顺铂25mg/m2,第1～3天,静脉滴注；21 d为1个疗程].调强放疗鼻咽大体肿瘤体积66.0 ～70.4 Gy,颈部淋巴结大体肿瘤体积66 Gy,临床高危靶体积60 Gy,临床低危靶体积54 Gy.结果新辅助化疗后的有效率为91.2％,主要急性不良反应为l～2级骨髓抑制.所有患者随访满3年,3年鼻咽局部控制率、区域控制率、无远处转移率、总生存率分别为93％、99％、91％、90％.3级晚期不良反应中张口困难1例、听力下降2例、颅神经损伤2例.结论吉西他滨和顺铂联合调强放疗局部晚期鼻咽癌有效、方便、耐受性良好,值得进一步探索药物最适当的治疗周期.
목적 평개길서타빈화순박여조강방료서관치료국부만기비인암적료효화불량반응.방법 71례국부만기비인암(Ⅲ기41례、ⅣA기30례)환자접수신보조화료、조강방료、보조화료,신보조화료、보조화료각2개료정[길서타빈1000 mg/m2,제1、8천정맥적주(＞ 30 min)；순박25mg/m2,제1～3천,정맥적주；21 d위1개료정].조강방료비인대체종류체적66.0 ～70.4 Gy,경부림파결대체종류체적66 Gy,림상고위파체적60 Gy,림상저위파체적54 Gy.결과 신보조화료후적유효솔위91.2％,주요급성불량반응위l～2급골수억제.소유환자수방만3년,3년비인국부공제솔、구역공제솔、무원처전이솔、총생존솔분별위93％、99％、91％、90％.3급만기불량반응중장구곤난1례、은력하강2례、로신경손상2례.결론 길서타빈화순박연합조강방료국부만기비인암유효、방편、내수성량호,치득진일보탐색약물최괄당적치료주기.
Objective To evaluate the efficacy and toxicity of gemcitabine plus cisplatin (GP)chemotherapy combined with intensity-modulated radiation therapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC).Methods 71 patients (Stage Ⅲ:41,Stage ⅣA:30) with locoregionally advanced NPC were entered this study.Neoadjuvant chemotherapy was consisted of cisplatin 25 mg/m2 intravenously on d1-3 and gemcitabine 1000 mg/m2 in 30 minutes intravenous infusion on days 1 and 8,every 3 weeks for 2 cycles.Adjuvant chemotherapy consisted of 2 cycles of the same GP regimen was given at 28 days after the end of radiotherapy.The prescription doses was 66.0-70.4 Gy to the gross tumor volume,66 Gy to positive neck nodes,60 Gy to the high-risk clinical target volume,54 Gy to the low-risk clinical target volume.Results The overall response rate to neoadjuvant chemotherapy was 91.2％,acute toxicity was mainly grade 1-2 myleosuppression.All patients completed IMRT.The median follow-up duration was 38 months.The 3-year nasopharyngeal local control,regional control,distant metastasis-free survival rate and overall survival rate were 93％,99％,91％,90％,respectively.Severe late toxicities included grade 3 trismus in 1 patient,grade 3 hearing impairment in 2 patients and cranial nerve palsy in 2 patients,respectively.No grade 4 late toxicities were observed.Conclusions The combination of GP chemotherapy and IMRT for locoregionally advanced nasopharyngeal carcinoma is well-tolerated,convenient,effective,and warrants further studies of more proper cycles of GP regimen.