本文選題：局部中晚期鼻咽癌 + 動(dòng)脈灌注�。� 參考：《大連醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的：明確動(dòng)脈灌注同步化療聯(lián)合調(diào)強(qiáng)放射治療在局部中晚期鼻咽癌(nasopharyngeal carcinoma, NPC)治療中的價(jià)值。 方法：采用前瞻性隨機(jī)對照研究,把病理確診的36例局部中晚期(Ⅱ-Ⅳa期)初治鼻咽癌患者在治療前隨機(jī)分成兩組。1 9例患者經(jīng)頸外動(dòng)脈進(jìn)行區(qū)域性動(dòng)脈灌注同步放化療(實(shí)驗(yàn)組),化療方案為“PF”方案,即放療前5天開始DDP 60 mg/m2供血?jiǎng)用}插管灌注,5-FU 1.0g/m2供血?jiǎng)用}插管灌注,區(qū)域動(dòng)脈灌注后5天即進(jìn)行放射治療,放療進(jìn)行四周后進(jìn)行第二次動(dòng)脈灌注化療。17例患者進(jìn)行全身靜脈化學(xué)治療(對照組),化療方案為“PF”方案,DDP 40 mg/m2第1～5天；5-FU 500 mg/m2第1～5天,化療方案完成1天后開始放療,放療進(jìn)行四周后進(jìn)行第二次全身化療。放療方案為調(diào)強(qiáng)放射治療(intensity modulated radiation therapy IMRT), CT模擬定位機(jī),行顱底骨至鎖骨下區(qū)層厚3mmCT增強(qiáng)掃描,將圖像通過局域網(wǎng)傳到飛利浦Pinnacle調(diào)強(qiáng)放射計(jì)劃系統(tǒng)。勾畫靶區(qū)：腫瘤靶區(qū)(GTV)根據(jù)臨床檢查、CT、MRI及PET—CT等影像檢查確定的腫瘤病灶,包括原發(fā)腫瘤、咽旁以及頸部的轉(zhuǎn)移淋巴結(jié),考慮擺位誤差外放3mm；臨床靶區(qū)(CTV)包括鼻咽壁、咽后及咽側(cè)間隙、下組篩竇、翼腭窩、顱底、后1／3鼻腔、上頜竇及頸部深淋巴結(jié)。鼻咽腫瘤區(qū)和腫大淋巴結(jié)區(qū)為GTVnx、GTVnd,高危亞臨床區(qū)和低危亞臨床區(qū)CTV1和CTV2,GTV、CTV1和CTV2的平均照射劑量分別達(dá)到了71.74Gy、68.84Gy、64.33Gy,平均分次劑量達(dá)到了2.04Gy以上。對比治療后的毒性反應(yīng)和近期療效。統(tǒng)計(jì)學(xué)方法采用χ2檢驗(yàn)。 結(jié)果：1.毒副反應(yīng)：在36例中晚期鼻咽癌的治療中,大部分患者都出現(xiàn)了放療、化療毒副反應(yīng),但輕重不一。主要表現(xiàn)有口腔粘膜反應(yīng)、口腔潰瘍和口干無味;胃腸道反應(yīng)如惡心、嘔吐和納差；放射部位皮膚干濕性皮炎；白細(xì)胞減少、血小板減少、靜脈炎等,肝腎功能無明顯損害。從(表2)可以看出,口腔粘膜反應(yīng)、腮腺炎和血小板減少在實(shí)驗(yàn)組和對照組無明顯差異,P0.05.白細(xì)胞減少和胃腸道反應(yīng)的情況在兩組有明顯差異,P0.05。2.近期療效：所有病例均在放療結(jié)束后3個(gè)月、6個(gè)月、1年評定療效,實(shí)驗(yàn)組3個(gè)月CR 5例,PR 14例,NC 0例,PD 0例；6個(gè)月CR 7例,PR 12例,NC 0例,PD 0例：1年CR 8例,PR 9例,NC 1例,PD 1例；3個(gè)月總緩解率(CR+PR)為100%(19／19)；6個(gè)月總緩解率(CR+PR)為100%(19／19)；1年總緩解率(CR+PR)為89.5%(17／19)。對照組3個(gè)月CR 3例,PR 13例,NC 2例,PD0例；6個(gè)月CR 5例,PR 10例,NC 3例,PD 0例；1年CR 6例,PR 7例,NC 2例,PD 2例；3個(gè)月總緩解率(CR+PR)為94.1%(16／1 7)；6個(gè)月總緩解率(CR+PR)為88.2%(15／17)；1年總緩解率(CR+PR)為76.5%(13／17)。用χ2檢驗(yàn),P0.05,兩者比較差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論：經(jīng)頸外動(dòng)脈灌注同步放化療能減少全身用藥劑量,同時(shí)增加局部藥物濃度,減輕化療藥物對患者的毒性反應(yīng)。同時(shí)明顯降低遠(yuǎn)處轉(zhuǎn)移提高患者的生存質(zhì)量和提高生存率。對頸外動(dòng)脈灌注同步化放療治療中晚期鼻咽癌療效明顯優(yōu)于全身同步化療及放療治療中晚期鼻咽癌。
[Abstract]:Objective : To evaluate the value of intra - arterial perfusion synchronous chemotherapy combined with radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma ( NPC ) .


Methods : Thirty - six patients with nasopharyngeal carcinoma ( NPC ) were randomly divided into two groups before treatment with a prospective randomized controlled study .
5 - FU 500 mg / m 2 days 1 - 5 , after the chemotherapy regimen was completed for 1 day , radiotherapy was started , and the second systemic chemotherapy was carried out after radiotherapy . The radiotherapy regimen consisted of intensity modulated radiation therapy IMRT , CT simulated positioning machine , skull base bone to subclavian region layer thickness 3mmCT enhanced scanning .
The mean irradiation doses of CTV1 and CTV2 , GTV , CTV1 and CTV2 were 71.74Gy , 68.84Gy , 64.33Gy , respectively . The average doses of CTV1 and CTV2 , GTV , CTV1 and CTV2 in the nasopharyngeal tumor area and the enlarged lymph node area were 71.74Gy , 68.84Gy , 64.33Gy , respectively .


Results : 1 . Toxic side reaction : In the treatment of 36 patients with advanced nasopharyngeal carcinoma , most of the patients had radiotherapy and chemotherapy toxicity , but the severity was different . The main manifestations were oral mucosa reaction , oral ulcer and dry mouth , and gastrointestinal reactions such as nausea , vomiting and anorexia .
Radiation site skin dry and wet dermatitis ;
There was no significant difference in the function of liver and kidney between the experimental group and the control group ( P < 0.05 ) . The results showed that there were no significant difference between the experimental group and the control group , P < 0.05 . 2 . Short term effect : All cases were evaluated in 3 months , 6 months and 1 year after radiotherapy .
6 months CR 7 cases , PR 12 cases , NC 0 cases , PD 0 cases : 1 year CR 8 cases , PR 9 cases , NC 1 case , PD 1 case ;
The total response rate ( CR + PR ) was 100 % ( 19 / 19 ) in 3 months .
The total response rate ( CR + PR ) of 6 months was 100 % ( 19 / 19 ) .
1 - year response rate ( CR + PR ) was 89.5 % ( 17 / 19 ) . The control group was 3 months CR 3 , PR 13 , NC 2 , PD0 .
6 months CR 5 cases , PR 10 cases , NC 3 cases , PD 0 cases ;
1 year CR 6 cases , PR 7 cases , NC 2 cases , PD 2 cases ;
The total response rate ( CR + PR ) was 94.1 % ( 16 / 17 ) in 3 months .
The total response rate ( CR + PR ) was 88.2 % ( 15 / 17 ) in 6 months .
The total response rate ( CR + PR ) was 76.5 % ( 13 / 17 ) in 1 year .


Conclusion : Combined chemotherapy with external carotid artery perfusion can reduce systemic dosage , increase local drug concentration , reduce the toxicity of chemotherapeutic drugs to patients , and decrease the distant metastasis to improve the survival quality and survival rate of patients .

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R739.63

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