CAJ | 학술논문

目的比较局部晚期鼻咽癌患者诱导化疗+IMRT同期化疗与IMRT同期化疗的远期疗效.方法回顾分析2001-2008年收治的278例局部晚期鼻咽癌患者资料,其中IMRT同期化疗133例,诱导化疗+IMRT同期化疗145例.结果随访率为96.6％.全组患者5年OS为78.1％,DMFS为78.0％,LRFS为90.6％,PFS为72.0％.IMRT同期化疗和诱导化疗+IMRT同期化疗的5年OS、DMFS、RFS、PFS分别为79.9％和76.4％ (P =0.443)、77.1％和78.9％ (P=0.972)、91.6％和89.8％ (P =0.475),71.6％和72.2％ (P=0.731).亚组分析显示T3 ～4 N0 ～1期患者诱导化疗+IMRT同期化疗并未明显改善LRFS (90.7％∶86.9％,P=0.376),N晚期患者诱导化疗+IMRT同期化疗也并未明显改善MFS (57.6％∶69.7％,P=0.275).诱导化疗+IMRT同期化疗的中性粒细胞减少、血红蛋白减少和上消化道反应明显增加(100∶52,P=0.000;64∶35,P=0.010;90∶63,P=0.044).结论对局部晚期鼻咽癌患者,与IMRT同期化疗相比,诱导化疗+IMRT同期化疗并未明显改善患者预后,且≥3级中性粒细胞减少、血红蛋白减少和上消化道反应明显增加.诱导化疗在局部晚期鼻咽癌治疗中的作用仍需进一步研究.
목적 비교국부만기비인암환자유도화료+IMRT동기화료여IMRT동기화료적원기료효.방법 회고분석2001-2008년수치적278례국부만기비인암환자자료,기중IMRT동기화료133례,유도화료+IMRT동기화료145례.결과 수방솔위96.6％.전조환자5년OS위78.1％,DMFS위78.0％,LRFS위90.6％,PFS위72.0％.IMRT동기화료화유도화료+IMRT동기화료적5년OS、DMFS、RFS、PFS분별위79.9％화76.4％ (P =0.443)、77.1％화78.9％ (P=0.972)、91.6％화89.8％ (P =0.475),71.6％화72.2％ (P=0.731).아조분석현시T3 ～4 N0 ～1기환자유도화료+IMRT동기화료병미명현개선LRFS (90.7％∶86.9％,P=0.376),N만기환자유도화료+IMRT동기화료야병미명현개선MFS (57.6％∶69.7％,P=0.275).유도화료+IMRT동기화료적중성립세포감소、혈홍단백감소화상소화도반응명현증가(100∶52,P=0.000;64∶35,P=0.010;90∶63,P=0.044).결론 대국부만기비인암환자,여IMRT동기화료상비,유도화료+IMRT동기화료병미명현개선환자예후,차≥3급중성립세포감소、혈홍단백감소화상소화도반응명현증가.유도화료재국부만기비인암치료중적작용잉수진일보연구.
Objective To compare the long-term efficacy between two radiochemotherapy regimens for locally advanced nasopharyngeal carcinoma (NPC):intensity-modulated radiotherapy with concurrent chemotherapy (CCRT) versus neoadjuvant chemotherapy (NACT) followed by CCRT.Methods A retrospective analysis was performed on the clinical data of 278 patients with locally advanced NPC who were admitted to our hospital from 2001 to 2008.Of the 278 patients,133 received CCRT,and 145 received NACT followed by CCRT (NACT + CCRT).Results The follow-up rate was 96.6％.The 5-year overall survival (OS),distant metastasis-free survival (DMFS),recurrence-free survival (RFS),and progression-free survival (PFS) were 78.1％,78.0％,90.6％,and 72.0％,respectively.There were no significant differences between the CCRT group and NACT + CCRT group in 5-year OS (79.9％ vs.76.4％,P =0.443),DMFS (77.1％ vs.78.9％,P=0.972),RFS (91.6％ vs.89.8％,P=0.475),and PFS (71.6％ vs.72.2％,P=0.731).Subgroup analysis showed that compared with CCRT,NACT + CCRT did not significantly improve 5-year RFS in T3-4N0-1 patients (90.7％ vs.86.9％,P=0.376) and did not significantly improve 5-year DMFS in patients with advanced N-stage disease (57.6％ vs.69.7％,P =0.275).There were significantly higher numbers of individuals with neutropenia,decrease in hemoglobin,and upper gastrointestinal reactions in patients treated with NACT + CCRT than in those treated with CCRT (100 vs.52,P=0.000;64 vs.35,P=0.010;90 vs.63,P=0.044).Conclusions Compared with CCRT,NACT + CCRT does not significantly improve the prognosis in patients with locally advanced NPC and leads to significant increases in grade ≥ 3 toxicities (neutropenia,decrease in hemoglobin,and upper gastrointestinal reactions).The role of NACT in the treatment of locally advanced NPC needs further study