本文選題：鼻咽癌 + 同期放化療��； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:比較同期放化療(CRT)及尼妥株聯(lián)合放療(NRT)治療局部晚期鼻咽癌的遠(yuǎn)期療效和毒副反應(yīng)。方法:收集2010年1月-2012年12月至我院腫瘤科接受治療的初治局部晚期鼻咽癌患者64例,其中36例接受順鉑聯(lián)合同期放療,28例接受尼妥株聯(lián)合放療。所有患者放療前均行DP方案誘導(dǎo)化療2周期:多西他賽75mg/m2 d1,順鉑35mg/m2 d1-2,每3周為1個(gè)療程。2周期誘導(dǎo)化療后2-3周行根治性放療。CRT組:順鉑40mg/m2/w,共6次。NRT組:尼妥株單抗200mg/w,共6次。兩組均采用調(diào)強(qiáng)放療技術(shù),處方劑量PGTV-nx:66-70Gy/30F;PGTV-nd:60-70Gy/30F;鼻咽高危亞臨床靶區(qū)PCTV-60:60Gy/30F;鼻咽低危亞臨床靶區(qū)PTV-54:54Gy/30F。每日1次,每周5次。結(jié)果:遠(yuǎn)期療效:CRT組3年總生存率為83.3%,NRT組3年總生存率為82.1%,P=0.868,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;CRT組3年無(wú)進(jìn)展生存率77.8%,NRT組3年無(wú)進(jìn)展生存率為75.0%,P=0.819,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;CRT組3年無(wú)局部區(qū)域復(fù)發(fā)率為91.7%,NRT組3年無(wú)局部區(qū)域復(fù)發(fā)率為89.3%,P=0.760,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;CRT組3年無(wú)遠(yuǎn)處轉(zhuǎn)移率為86.1%,NRT組3年無(wú)遠(yuǎn)處轉(zhuǎn)移率為85.7%,P=0.947,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義。急性毒性反應(yīng):III/IV級(jí)白細(xì)胞減少CRT組為38.9%,NRT組為14.3%,P=0.030,兩組差異有統(tǒng)計(jì)學(xué)意義;III/IV級(jí)中性粒細(xì)胞減少CRT組為33.3%,NRT組10.7%,P=0.034,兩組差異有統(tǒng)計(jì)學(xué)意義;血小板減少發(fā)生率CRT組為5.6%,NRT組為10.7%,P=0.646,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;III/IV級(jí)貧血CRT組為16.7%,N-RT組為0,P=0.031,兩組差異有統(tǒng)計(jì)學(xué)意義;I/II級(jí)嘔吐CRT組為50%,NRT組為25%,P=0.042,兩組有統(tǒng)計(jì)學(xué)意義;III/IV級(jí)嘔吐CRT組為27.8%,NRT組為0,P=0.003,兩組差異有統(tǒng)計(jì)學(xué)意義。放療相關(guān)急性毒副反應(yīng):I/II級(jí)口腔黏膜炎CRT組為38.9%,NRT組為42.9%,P=0.621,兩組差異無(wú)統(tǒng)計(jì)學(xué)依依;I/II級(jí)皮膚反應(yīng)CRT組為36.1%,NRT組為39.3%,P=0.795,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;III/IV級(jí)皮膚反應(yīng)CRT組為25.0%,NRT組為25%,P=1.000,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;III/IV反應(yīng)級(jí)口腔黏膜炎CRT組為33.3%,NRT組為28.6%,P=0.683,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義。放療相關(guān)晚期毒性:I-IV級(jí)放射性脊髓病兩組均未出現(xiàn);I/II級(jí)放射性腦病發(fā)生率CRT組為5.6%,NRT組為3.6%,P=0.709,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;III/IV放射性腦病兩組均未出現(xiàn);I/II級(jí)放射性放射性組織纖維化發(fā)生率CRT組為8.3%,NRT組為3.6%,P=0.435,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;III/IV級(jí)放射性纖維組織化兩組均未出現(xiàn);I/II級(jí)唾液腺放射損傷CRT組為77.8%,NRT組為82.1%,P=0.667,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;III/IV唾液腺損傷兩組均未出現(xiàn);I/II級(jí)耳部放射損傷CRT組為22.2%,NRT組為21.4%,P=0.939,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義;III/IV級(jí)耳部放射性損傷兩組均未出現(xiàn)。具體見(jiàn)表3.4。結(jié)論:CRT組與NRT組對(duì)局部晚期鼻咽癌患者遠(yuǎn)期療效相似;毒副反應(yīng)方面:CRT組III/IV級(jí)白細(xì)胞減少、III/IV級(jí)中性粒細(xì)胞減少、III/IV級(jí)貧血、I-IV級(jí)嘔吐反應(yīng)明顯高于NRT組,差異具有統(tǒng)計(jì)學(xué)意義;兩組放療相關(guān)急性毒副反應(yīng)和晚期損傷無(wú)統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective: to compare the long term effects and side effects of CRT and NRTT in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Methods: from January 2010 to December 2012, 64 patients with locally advanced nasopharyngeal carcinoma were treated from January 2010 to December 2012 in our hospital. Among them, 36 cases received cisplatin combined with concurrent radiotherapy and 28 cases received nitrite strain combined radiotherapy. All patients were treated with DP regimen induction chemotherapy for 2 cycles before radiotherapy: docetaxel 75mg/m2 D1, cisplatin 35mg/m2 d1-2, radical radiotherapy / CRT group: cisplatin 40 mg / m ~ 2 / w, n = 6 times 路NRT group: nitrite McAb 200mg / w, every 3 weeks for 2 to 3 weeks after induction chemotherapy. Both groups were treated with intensity-modulated radiotherapy. The prescription dose of PGTV-nx: 66-70Gy / 30FN PGTV-ndw 60-70Gy / 30F; the high risk subclinical target of nasopharynx, PCTV-60: 60Gy / 30F; and the subclinical target area of low risk of nasopharynx, PTV-54 / 54Gy / 30F. Once a day, 5 times a week. Results: the 3 year overall survival rate of the 7: 8% CRT group was 83.3%. The 3-year overall survival rate of the NRT group was 82.1%. There was no significant difference between the two groups. There was no significant difference between the two groups in the 3-year progressive free survival rate (77.8%) in the NRT group, and there was no significant difference between the two groups in the 3-year progression-free survival rate (75.0%). There was no significant difference between the two groups. The 3-year non-local recurrence rate was 91.7% in the NRT group and 89.3% in the CRT group. There was no significant difference between the two groups. The non-distant metastasis rate in the CRT group was 86.1% and the non-distant metastasis rate in the NRT group was 85.7%. There was no significant difference between the two groups. Acute toxic reaction: grade III / IV leukopenia in CRT group was 38.9% and that in NRT group was 14.3i / Pn.0.030, and the difference between the two groups was statistically significant: 33.3i / IV grade neutropenia CRT group was 33.3i / IV grade CRT group (10.7%), and the difference between the two groups was statistically significant (P < 0.05). The incidence of thrombocytopenia in CRT group was 10.7 / 0.646, and there was no significant difference between the two groups. There was no significant difference between the two groups. In the CRT group of grade III / IV anemia, it was 16.7and 0.031 in N-RT group, and the difference between the two groups was statistically significant. The difference between the two groups was statistically significant: 50 P0.042 in 50 NRT group. There was statistical significance between the two groups in grade III- IV vomiting CRT. The difference between the two groups was statistically significant. There was no significant difference between the two groups (38.9%) and NRT group (42.9% P0.621), and there was no significant difference between the two groups. The difference between the two groups was 36.1% (P 0.795), and there was no significant difference between the two groups. The difference between the two groups was 25.0% and 25.0% (P = 1.000), and the difference between the two groups was significant (P < 0.05), but the difference between the two groups was not significant (P < 0.05), but the difference between the two groups was not statistically significant (P < 0.05), but the difference between the two groups was not statistically significant (P < 0.05), but the difference between the two groups was not statistically significant (P < 0.05). There was no significant difference between the two groups. There was no significant difference between the two groups. There was no significant difference between the two groups. The CRT group was 33.3and the NRT group was 28.60.683. there was no significant difference between the two groups. The incidence of radiation associated advanced toxicity I-IV radiation encephalopathy in the CRT group was 5.6%, and the incidence of radiation encephalopathy in the CRT group was 3.6%. 709 in the CRT group. There was no significant difference between the two groups. There was no significant difference between the two groups in the incidence of radiation encephalopathy of grade I / II. There was no significant difference between the two groups in the incidence of radiation encephalopathy of grade I / II. The incidence of fibrous fibrosis in CRT group was 8.3g / NRT 3.60.35. there was no significant difference between the two groups. There was no significant difference between the two groups. There was no significant difference between the two groups. There was no significant difference between the two groups in the incidence of radiation injury of salivary glands of grade I / II in CRT group and in the CRT group (P = 82.66), and there was no significant difference between the two groups in terms of salivary glands of III / IV in CRT group and 77.8% in NRT group (P = 0.667). No I / II grade radiation injury was found in the two groups. In CRT group, 22.2% NRT was 21.4% P0. 939. There was no significant difference between the two groups. There was no significant difference between the two groups in grade III / IV radiation injury. See table 3.4 for details. Conclusion the long term curative effect of the two groups is similar to that of the NRT group, and the side effects of the two groups are significantly higher than that of the NRT group in the grade III / IV neutropenia and grade III / IV anemia, and the difference is statistically significant. There was no significant difference in radiation associated acute side effects and late injury between the two groups.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.63

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