CAJ | 학술논문

目的：观察比较调强放疗联合化疗与单纯调强适形放疗治疗鼻咽癌的临床疗效、急性反应及晚期损伤。方法：初治鼻咽癌患者72例，均为Ⅲ～Ⅳa期；随机接受单纯根治性放疗+序贯化疗（30例）和同步放化疗+序贯化疗（42例）。鼻咽和颈部靶体积均采用调强适形放疗（intensity modulated radiation therapy，IMRT）技术照射。采用Kaplan-Meier法进行生存分析，RTOG/EORTC标准评价急性反应和晚期损伤。结果：本组中位随访时间13.5个月，单纯放疗组1、2年局部区域无进展和无远处转移生存率及总生存率分别为95.0%、80.0%、95.0%和80.0%、60.0%、75.0%；同步放化疗组1、2年局部区域无进展和无远处转移生存率及总生存率分别为100%、96.4%、96.4%和100%、92.9%、92.9%；两组间2年局部区域无进展生存率（χ2=3.951，P=0.047）和无远处转移生存率（χ2=3.858，P=0.049）差异有统计学意义，2年总生存率差异无统计学意义（χ2=1.334，P=0.248）。多数患者仅表现为1～2级放疗急性反应和0～1级放疗晚期损伤，两组差异均无统计学意义（P>0.05），未观察到4级急性反应和晚期损伤；在晚期损伤症口干表现中，两组差异有统计学意义（P<0.05）。化疗相关不良反应中，两组的白细胞、中性粒细胞抑制及消化道反应差异有统计学意义（P<0.05）；体重下降方面两组差异无统计学意义（P>0.05）。结论：IMRT联合同步化疗治疗局部晚期鼻咽癌患者可获得较好的局部区域及远处转移控制率，两者急性放射损伤无显著性差异；晚期损伤方面联合治疗患者较易出现口干等症状；联合治疗组亦能顺利完成治疗。
목적：관찰비교조강방료연합화료여단순조강괄형방료치료비인암적림상료효、급성반응급만기손상。방법：초치비인암환자72례，균위Ⅲ～Ⅳa기；수궤접수단순근치성방료+서관화료（30례）화동보방화료+서관화료（42례）。비인화경부파체적균채용조강괄형방료（intensity modulated radiation therapy，IMRT）기술조사。채용Kaplan-Meier법진행생존분석，RTOG/EORTC표준평개급성반응화만기손상。결과：본조중위수방시간13.5개월，단순방료조1、2년국부구역무진전화무원처전이생존솔급총생존솔분별위95.0%、80.0%、95.0%화80.0%、60.0%、75.0%；동보방화료조1、2년국부구역무진전화무원처전이생존솔급총생존솔분별위100%、96.4%、96.4%화100%、92.9%、92.9%；량조간2년국부구역무진전생존솔（χ2=3.951，P=0.047）화무원처전이생존솔（χ2=3.858，P=0.049）차이유통계학의의，2년총생존솔차이무통계학의의（χ2=1.334，P=0.248）。다수환자부표현위1～2급방료급성반응화0～1급방료만기손상，량조차이균무통계학의의（P>0.05），미관찰도4급급성반응화만기손상；재만기손상증구간표현중，량조차이유통계학의의（P<0.05）。화료상관불량반응중，량조적백세포、중성립세포억제급소화도반응차이유통계학의의（P<0.05）；체중하강방면량조차이무통계학의의（P>0.05）。결론：IMRT연합동보화료치료국부만기비인암환자가획득교호적국부구역급원처전이공제솔，량자급성방사손상무현저성차이；만기손상방면연합치료환자교역출현구간등증상；연합치료조역능순리완성치료。
Objective:To investigate the differences in efficacy, survival outcomes, and acute and late toxicities for patients with local/regional advanced nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) in combination with che-motherapy (CT) and by IMRT alone. Methods:A total of 72 newly diagnosed local/regional advanced NPC patients were randomly subjected to IMRT/RT+adjuvant CT (after radiotherapy, RT) (n=42) or IMRT+adjuvant CT (after RT) (n=30). The Kaplan-Meier meth-od was used to analyze the two-year local/regional control rates, distant metastasis-free survivals, and overall survivals. The acute and late radiation toxicities were evaluated based on the toxicity criteria of the Radiation Therapy Oncology Group and European Organiza-tion for Research and Treatment of Cancer. Results:A median follow up period of 13.5 months was included in the study. The one-year and two-year local/regional control rates, distant metastasis-free survivals, and overall survival in the IMRT group were 95.0%, 80.0%, and 95.0%, and 80%, 60.0%, and 75.0%, respectively. For the IMRT+CT group, such rates were 100%, 96.4%, and 96.4%, and 100%, 92.9%, and 92.9%, respectively. The two-year local/regional control rate and distant metastasis-free survivals in the IMRT+CT group were higher than those in the IMRT group (P<0.05). Most patients had grade 1 to grade 2 acute radiation toxicities and grade 0 to grade 1 late radiation toxicities (P>0.05). No patient showed a grade 4 acute or late toxicity. The blood and gastrointestinal toxicity rates were high in the IMRT+CT group (P<0.05). Conclusion:The IMRT+CT treatment has potential advantages over the IMRT in the treatment of local/regional advanced NPC patients in terms of local/regional control and overall survival. The blood and gastrointestinal toxicity rates in the IMRT+CT group were higher than in the IMRT group but still within a tolerable range.