Ⅱ期鼻咽癌患者单纯放疗、同步放化疗及同步 放化疗联合辅助化疗的预后分析

Prognostic analysis of intensity-modulated radiotherapy alone, concurrent chemoradiotherapy and concurrent chemoradiotherapy combined with adjuvant chemotherapy in patients with stage II nasopharyngeal carcinoma

摘要:

目的 通过比较单纯放疗（IMRT）、同步放化疗（CCRT）及同步放化疗联合辅助化疗（CCRT+AC） 在Ⅱ期鼻咽癌患者中的生存获益，来探索化疗是否能提高Ⅱ期鼻咽癌患者生存率，为早期鼻咽癌治疗方式的 选择提供参考依据。方法 回顾性分析2009 年10 月—2013 年10 月中南大学湘雅医院肿瘤科收治的122 例 初治Ⅱ期鼻咽癌患者（T1、2N1M0、T2N0M0，第八版AJCC/UICC 鼻咽癌分期标准）的临床资料。其中， IMRT 组患者39 例，CCRT 组患者38 例，CCRT+AC 组患者45 例。主要研究终点为总生存期（OS）、无 局部复发生存期（LRFS）、无远处转移生存期（DMFS）及无病生存期（DFS），次要研究终点为毒副反应。 结果 IMRT 组、CCRT 组、CCRT+AC 组患者5 年OS、LRFS、DMFS 及DFS 比较，差异无统计学意义 （P >0.05）；但CCRT 组、CCRT+AC 组患者毒副反应（骨髓抑制、胃肠道反应）较IMRT 组更严重（P <0.05）。 结论 在IMRT 基础上加用化疗未能改善Ⅱ期鼻咽癌患者的预后，反而增加毒副反应。

Abstract:

Objective To explore whether chemotherapy can improve the survival rate of patients with stage II nasopharyngeal carcinoma, and provide a reference for the choice of treatment methods for early nasopharyngeal carcinoma by comparing the survival benefit of three kinds of treatment methods: intensity-modulated radiotherapy alone (IMRT), concurrent chemoradiotherapy (CCRT) and concurrent chemoradiotherapy combined with adjuvant chemotherapy (CCRT+AC) for stage Ⅱ nasopharyngeal carcinoma Methods The clinical data of 122 patients with nasopharyngeal carcinoma treated with tumor in Xiangya Hospital from October 2009 to October 2013 were analyzed retrospectively (T1-2N1M0, T2N0M0, eighth edition of AJCC/UICC nasopharyngeal carcinoma staging standard). There were 39 patients in the IMRT group, 38 patients in the CCRT group, and 45 patients in the CCRT+AC group. The primary endpoints were overall survival (OS), no local recurrence survival (LRFS), no distant metastasis survival (DMFS), and disease-free survival (DFS). The secondary endpoint was toxicities. Results There was no significant difference in 5-year OS, LRFS, DMFS and DFS among the IMRT group, CCRT group and CCRT+AC group (P > 0.05). However, the side effects (bone marrow suppression, gastrointestinal reaction) in the CCRT group and the CCRT+AC group were more serious than those in the IMRT group alone (P < 0.05). Conclusions On the basis of IMRT combined with chemotherapy failed to improve prognosis of stage Ⅱ nasopharyngeal carcinoma. However, it increases adverse reaction.