Objective: To evaluate the clinical effects of the combined late course accelerated hyperfractionation radiotherapy (LCAHR) and chemotherapy on stage Ⅲ-Ⅳa nasopharyngeal carcinoma (NPC).Methods: A total of 60 NPC patients with stage Ⅲ-Ⅳa disease were randomly divided into the conventional control group (group A) treated with traditional fractionated radiotherapy, and the study group (group B) treated with LCAHR combined with chemotherapy.A traditional irradiation of 40 Gy at the two opposing facial-cervical anterior-posterior fields (AP-PA) was conducted in both groups, with 20 fractions completed within 4 weeks.After reduction of the irradiated field, LCAHR was performed in group B with a dose of 1.2Gy/f, 2 fractions a day at a 4-6 hour interval, for 14-15 days.The total dose for NPC was 73.6Gy～76Gy in 7 weeks.Chemotherapeutic PF regimen was administered concurrently with radiotherapy.Group A received conventional radiotherapy with a total dose of 70Gy～74Gy for 7 - 7.5 weeks.Results: The rate of complete regression of NPC was 96.6％ (29/30) in group B and 93.3％ (28/30) in group A at the end of the course (P＞0.05).The 1- and 3-year local control rates in group B and group A were 93.1％ and 89.6％, and 82.1％ and 67.8％, respectively.The 1- and 3- year survival rates were 96.5％ (28/29) and 93.1％ (27/29) in group B, and 92.8％ (26/28) and 71.4％ (20/28) in group A (P＜ 0.05).The incidence of acute radiation response was obviously higher in group B than in group A.The incidences of long-term adverse reactions, such as dry mouth and fibrosis of the soft tissues of the neck, were lower in group B than in group A.Conclusion: LCAHR can improve the local control rate and the survival rate of NPC patients.Combining LCAHR with chemotherapy can reduce distant metastasis of NPC, with tolerable adverse reactions.%目的:评价后程超分割放疗联合化疗治疗Ⅲ～Ⅳa鼻咽癌的疗效.方法:60例Ⅲ～Ⅳa期鼻咽癌采用随机分组为常规组、后程超分割同步化疗组.均先采用面颈联合野常规分割对穿照射40 Gy,20次4周完成.后超组缩野后改用后程超分割调强放疗,1.2Gy/次,2次/天,共14-15天完成.鼻咽病灶总DT 73.6～76Gy/7周.且在放疗同时给予PF方案治疗.对照组缩野后给予常规照射2Gy/次,鼻咽病灶DT 70～74Gy/35～37次/7～7.5周.结果:后程超分割调强放疗同步化疗组与常规组肿瘤消退率分别为96.6%(29/30)、93.3%(28/30)(P＞0.05),1、3年肿瘤局部控制率分别为93.1%、89.6%和82.1%、67.8%.1、3年生存率分别为96.5%、93.1%和92.8%、71.4%(P＜0.05).后程超分割调强放疗同步化疗组的急性放疗反应显著高于常规分割放疗组.远期不良反应如口干及颈部软组织纤维化低于常规分割放疗组.结论:后程超分割调强放疗可提高局部晚期鼻咽癌的局控率及生存率,放化疗结合可降低远处转移率,毒副反应可耐受.
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