同步放化疗治疗72例儿童青少年鼻咽癌临床疗效

摘要

目的:探讨同步化放疗治疗儿童青少年鼻咽癌的临床疗效及安全性.方法:72例儿童青少年鼻咽癌患者,随机分为两组,同步化放疗组40例,采用同步化疗+放疗,鼻咽部照射剂量DT 62-68Gy/7-9周,放疗前及放疗第4周予以PF方案化疗2周期,DDP 20mg/m2,d1-3天,5-FU,400mg/m2,d1-3天.单放组32例,采用单纯放疗,鼻咽部照射剂量DT 66-70Gy/7-8周.治疗期间密切观察口腔黏膜反应,消化道反应及白细胞下降情况,治疗后3个月对肿瘤消退情况做近期疗效评价,以3、5年生存率做长期疗效评价.结果:同步化放疗组CR62.5%(25/40),PR30%(14/40),总有效率为92.5%(37/40),3、5年生存率分别为82.5%(33/40)和70%(29/40),明显好于单放组.化放疗组口腔黏膜炎,消化道反应和白细胞下降明显高于单放组,但经对症处理后患者可耐受.结论:儿童青少年鼻咽癌同步化放疗可以提高局控率和生存率,不良反应可耐受.%Objective:To investigate the clinical efficacy and safety of concurrent chemotherapy and radiotherapy for nasopharyngeal carcinoma in children and adolescents. Methods: All 72 cases of nasopharyngeal carcinoma in children and adolescents were randomized into two groups: 40 were treated with concurrent chemoradiotherapy, while the other 32 with radiotherapy alone. The chemotherapy program in the combined group was as follows: cisplatin,20mg/m2 , i.v. D1-3 , flurouridine, 400mg/m2 , i.v. D1-3 , given at the first day and the 28th day of radiotherapy,totally 2 cycles. The prescribed dose to the nosopharynx for the combined group was 62 -68Gy/7 -9weeks, and 66 -70Gy/7 -8 weeks for the radiotherapy alone. To observe the oral mucositis, and neutropenia during the treatment period, and evaluate the recent efficacy 3 months and survival rate at 3 and 5 years after treatment. Results: CR, PR rates were 65.5％ ( 25/40 ) and 30％ ( 12/40 ) respectively for the combined group, while for the radiotherapy group were 46.9％( 15/32 ) and25％( 8/32 ) respectively.The effective rate, 3 - year and 5 - year survival rate were 92.5％ ( 37/40 ), 82.5 ％ ( 33/40 )and 70％ ( 29/40 )respectively for the combined group. And it was much better than that of radiotherapy alone group. The side effects such as mucositis, xerostomia and neutropenia in the concurrent chemoradiotherapy group were more frequently seen and severer than those in the radiotherapy alone group, but were well tolerated. Conclusion: The concurrent chemoradiotherapy as the management of nasopharyngeal carcinoma in children and adolescents could improve the local control and survival rate, the side effects could be tolerated.