福建医科大学学报
福建醫科大學學報
복건의과대학학보
Journal of Fujian Medical University
2015年
4期
231-235
,共5页
陈建武%张幸平%刘德鑫%汪茜%吴丽芳
陳建武%張倖平%劉德鑫%汪茜%吳麗芳
진건무%장행평%류덕흠%왕천%오려방
动脉%输注,动脉内%药物疗法,联合%鼻咽肿瘤%治疗效果
動脈%輸註,動脈內%藥物療法,聯閤%鼻嚥腫瘤%治療效果
동맥%수주,동맥내%약물요법,연합%비인종류%치료효과
arteries%infusions,intra-arterial%drug therapy,combination%nasopharyngeal neo-plasms%treatment outcome
目的：探讨动脉灌注化疗联合调强放疗治疗局部晚期鼻咽癌的远期疗效。方法选择首诊的局部晚期(T3T4和/或 N2N3)鼻咽癌患者120例,分2组治疗：(1)动脉灌注给药放化疗60例(IAC 组)：先用多西他赛60~75 mg/m2 d1+顺铂75 mg/m2 d1,动脉灌注给药,21 d 为1个周期,连续使用2个周期,之后予以根治性同步放化疗,于放疗第1,22,43 d 同步使用顺铂75 mg/m2动脉灌注给药；(2)对照组60例：化疗方案同 IAC 组,静脉给药。所有病例均接受根治性调强放疗。采用 Kaplan-Meier 及 Log-rank 法计算和比较2组患者的生存率,Cox 比例风险模型多变量分析生存相关影响因素。结果(1)全组(IAC 组+对照组)3年及5年总生存率(OS)分别为77.83%,62.35%。IAC 组及对照组的3年 OS 分别为86.72%,72.13%,5年 OS 分别为78.85%,60.21%(P <0.05)。(2)IAC 组及对照组的3年无病生存率(DFS)分别为78.64%,56.21%,5年 DFS 分别为66.73%,50.12%(P <0.05)。(3)远期并发症主要表现为1,2级口干及感音性耳聋；IAC 组与对照组口干发生率为51.7%和48.3%,感音性耳聋为53.3%和56.7%,差别均无统计学意义。(4)主要失败原因为局部/区域复发及远处转移,IAC 组与对照组的总失败率及局部/区域复发率为35.0%和68.3%(P <0.05)及6.7%和38.3%(P <0.05)。(5)Cox 比例风险模型多变量分析提示影响患者生存的因素有：T 分期、N 分期、化疗给药途径、放疗剂量、血色素下降(≤80 g/L)、体质量下降(≥10%)。结论动脉灌注化疗联合调强放疗治疗局部晚期鼻咽癌远期临床疗效明显,使用安全,值得进一步加大病例数随机对照研究。
目的：探討動脈灌註化療聯閤調彊放療治療跼部晚期鼻嚥癌的遠期療效。方法選擇首診的跼部晚期(T3T4和/或 N2N3)鼻嚥癌患者120例,分2組治療：(1)動脈灌註給藥放化療60例(IAC 組)：先用多西他賽60~75 mg/m2 d1+順鉑75 mg/m2 d1,動脈灌註給藥,21 d 為1箇週期,連續使用2箇週期,之後予以根治性同步放化療,于放療第1,22,43 d 同步使用順鉑75 mg/m2動脈灌註給藥；(2)對照組60例：化療方案同 IAC 組,靜脈給藥。所有病例均接受根治性調彊放療。採用 Kaplan-Meier 及 Log-rank 法計算和比較2組患者的生存率,Cox 比例風險模型多變量分析生存相關影響因素。結果(1)全組(IAC 組+對照組)3年及5年總生存率(OS)分彆為77.83%,62.35%。IAC 組及對照組的3年 OS 分彆為86.72%,72.13%,5年 OS 分彆為78.85%,60.21%(P <0.05)。(2)IAC 組及對照組的3年無病生存率(DFS)分彆為78.64%,56.21%,5年 DFS 分彆為66.73%,50.12%(P <0.05)。(3)遠期併髮癥主要錶現為1,2級口榦及感音性耳聾；IAC 組與對照組口榦髮生率為51.7%和48.3%,感音性耳聾為53.3%和56.7%,差彆均無統計學意義。(4)主要失敗原因為跼部/區域複髮及遠處轉移,IAC 組與對照組的總失敗率及跼部/區域複髮率為35.0%和68.3%(P <0.05)及6.7%和38.3%(P <0.05)。(5)Cox 比例風險模型多變量分析提示影響患者生存的因素有：T 分期、N 分期、化療給藥途徑、放療劑量、血色素下降(≤80 g/L)、體質量下降(≥10%)。結論動脈灌註化療聯閤調彊放療治療跼部晚期鼻嚥癌遠期臨床療效明顯,使用安全,值得進一步加大病例數隨機對照研究。
목적：탐토동맥관주화료연합조강방료치료국부만기비인암적원기료효。방법선택수진적국부만기(T3T4화/혹 N2N3)비인암환자120례,분2조치료：(1)동맥관주급약방화료60례(IAC 조)：선용다서타새60~75 mg/m2 d1+순박75 mg/m2 d1,동맥관주급약,21 d 위1개주기,련속사용2개주기,지후여이근치성동보방화료,우방료제1,22,43 d 동보사용순박75 mg/m2동맥관주급약；(2)대조조60례：화료방안동 IAC 조,정맥급약。소유병례균접수근치성조강방료。채용 Kaplan-Meier 급 Log-rank 법계산화비교2조환자적생존솔,Cox 비례풍험모형다변량분석생존상관영향인소。결과(1)전조(IAC 조+대조조)3년급5년총생존솔(OS)분별위77.83%,62.35%。IAC 조급대조조적3년 OS 분별위86.72%,72.13%,5년 OS 분별위78.85%,60.21%(P <0.05)。(2)IAC 조급대조조적3년무병생존솔(DFS)분별위78.64%,56.21%,5년 DFS 분별위66.73%,50.12%(P <0.05)。(3)원기병발증주요표현위1,2급구간급감음성이롱；IAC 조여대조조구간발생솔위51.7%화48.3%,감음성이롱위53.3%화56.7%,차별균무통계학의의。(4)주요실패원인위국부/구역복발급원처전이,IAC 조여대조조적총실패솔급국부/구역복발솔위35.0%화68.3%(P <0.05)급6.7%화38.3%(P <0.05)。(5)Cox 비례풍험모형다변량분석제시영향환자생존적인소유：T 분기、N 분기、화료급약도경、방료제량、혈색소하강(≤80 g/L)、체질량하강(≥10%)。결론동맥관주화료연합조강방료치료국부만기비인암원기림상료효명현,사용안전,치득진일보가대병례수수궤대조연구。
Objective To explore long term effect of arterial perfusion chemotherapy combined with Intensity-Modulated Radiotherapy(IMRT)on patients with Locally Advanced Nasopharyngeal Carci-noma(LANC). Methods 120 cases of LANC (T3 T4 and /or N2 N3 )first treated in our hospital were studied from January 2008 to June 2010. The experimental group(IAC group,intra-arterial chemo-radio-therapy,60 cases)was given two cycles induction chemotherapy,using intra-arterial infusion of docetaxel, 60~75 mg/m2 ,and cisplatin,75 mg/m2 on day 1,every 3 weeks followed by concurrent chemo-radiother-apy with cisplatin,75 mg/m2 ,day 1,22,and 43. The control group (60 cases)received the same scheme of chemotherapy as IAC,but intravenous administration. All received radical IMRT. The survival rates were analyzed and compared by Kaplan Meier and Log-rank. The survival related factors were ana-lyzed by Cox proportional hazard model for multivariate analysis. Results (1 )3-year and 5-year overall survival(OS)of the whole group(IAC+control group)was 77.83%,62.35%,respectively. 3-year OS in IAC and control group was 86.72%,72.13%,and 5-year OS was 78.85%,60.21%,respectively, P <0.05. (2)3-year disease-free survival(DFS)in IAC and control group was 78.64%,56.21%,and 5-year DFS was 66.73%,50.12%,respectively,P <0.05. (3)The long term complications were mainly mainly 1/2 degree of dry mouth and sensory deafness. The incidence of dry mouth in IAC and control group was 5 1.7% and 48.3%,respectively,P <0.05;and the rate of sensory deafness between the two group was 53.3% vs 56.7%,P <0.05,both without statistical significance. (4)Local/regional recur-rence and metastasis were the main failure causes. The total failure rate and local/regional recurrence rate of IAC group was significantly lower than that in control group,36.0% vs 68.0%(P < 0.05 )and 8.0% vs 38.0%(P <0.05 ),respectively. (5 )Cox proportional hazard model for multivariate analysis showed that the prognostic factors were:T/N staging,administration route of chemotherapy,radiothera-py dose,the decreased level of hemoglobin(≤ 80 g/L),weight loss(≥ 10%). Conclusion Intra-arterial chemotherapy combined with IMRT for LANC has obvious long-term clinical effect,and safety,worthy of increasing cases for further randomize control trail.
