本文選題：鼻咽癌 + 調(diào)強(qiáng)放療(IMRT)��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的回顧性分析IMRT同期放化療對(duì)比IMRT同期放化療+輔助化療在局部晚期鼻咽癌中的療效情況,評(píng)估兩種不用綜合治療模式在局部晚期鼻咽癌治療中的療效和毒副反應(yīng)情況。方法收集2007年1月至2014年12月在廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院放療科住院并行同步放化療±輔助化療鼻咽癌的Ⅱ-Ⅳb期患者797例,全組病人均經(jīng)病理確診為鼻咽癌,其中單純同步放化療(CCRT組)261例,同步放化療+輔助化療(CCRT+AC組)536例,兩組資料按1:1匹配后,得出新樣本進(jìn)行生存分析。用Kaplan-Meier法計(jì)算總生存率(OS)、無(wú)局部復(fù)發(fā)率(LFFS)、無(wú)遠(yuǎn)處轉(zhuǎn)移率(DMFS),并用Log-rank檢驗(yàn),Cox模型分析預(yù)后因素。結(jié)果經(jīng)匹配后,CCRT組與CCRT+AC組分別為261例、261例匹配成功。在入組的522例患者中共死亡32例,其中,CCRT組14例,CCRT+AC組18例;有20例出現(xiàn)復(fù)發(fā),其中CCRT組出現(xiàn)6例,CCRT+AC組出現(xiàn)14例;有42例出現(xiàn)轉(zhuǎn)移,CCRT組出現(xiàn)14例,CCRT+AC組出現(xiàn)28例。CCRT組1、2、3年OS率分別為97.9%、96.2%、86.9%;1、2、3年LFFS率分別為100.0%、96.5%、96.5%;1、2、3年DMFS率分別為97.4%、92.8%、89.0%,對(duì)比CCRT+AC組1、2、3年OS率分別為99.6%、97.4%、93.8%;1、2、3年LFFS率分別為99.2%、95.6%、93.2%;1、2、3年DMFS率分別為95.3%、91.8%、87.2%。兩組比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(χ2=2.072,P=0.150;χ2=0.363,P=0.547;χ2=0.875,P=0.350)。亞組分析結(jié)果提示,對(duì)于T4的鼻咽癌患者,同步放化療后加用輔助化療能顯著改善其生存情況(P=0.001)。CCRT組發(fā)生3-4級(jí)急性胃腸道反應(yīng)、骨髓抑制、皮膚及口腔黏膜反應(yīng)的發(fā)生率分別為3.1%(8/261)、21.5(56/261)、12.3%(32/261);而CCRT+AC組分別為3.1%(8/261)、26.8(70/261)、11.5%(30/261),兩組在毒副反應(yīng)方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P=1.000,P=0.152,P=0.787)。結(jié)論局部晚期鼻咽癌接受同步放化療后加用輔助化療對(duì)總生存率、無(wú)局部復(fù)發(fā)率及無(wú)遠(yuǎn)處轉(zhuǎn)移率的提高不明顯。但對(duì)于T4期鼻咽癌患者有可能可改善其總生存率,但需要更長(zhǎng)的隨訪時(shí)間及更多的研究來(lái)驗(yàn)證。輔助化療應(yīng)用于局部晚期鼻咽癌是安全且能耐受的。目的回顧性的對(duì)比局部晚期鼻咽癌患者IMRT聯(lián)合化療±靶向治療的療效與其不良反應(yīng),初步評(píng)價(jià)在放化療基礎(chǔ)上加用靶向藥物的必要性。方法收集2007—2014年間接受IMRT聯(lián)合同步化療±輔助化療加靶向治療的Ⅲ—Ⅳb期鼻咽癌患者42例(試驗(yàn)組),同期僅行IMRT聯(lián)合同步放化療±輔助化療的患者與其按1∶4配對(duì)入組168例(對(duì)照組)。Kaplan-Meie r法計(jì)算生存率并Logrank檢驗(yàn)差異,余用χ2檢驗(yàn)。結(jié)果隨訪率為100%,試驗(yàn)組、對(duì)照組3年樣本量分別為42例、168例。試驗(yàn)組3年OS、LRFS、DMFS率分別為94%、100%、92%,對(duì)照組的分別為87.3%、94.6%、89.1%(P=0.647、0.193、0.744)。3—4級(jí)胃腸道不良反應(yīng)、骨髓抑制及口腔黏膜反應(yīng)發(fā)生率試驗(yàn)組分別為7%(3/42)、26%(11/42)、41%(17/42),對(duì)照組分別為3.6%(6/168)、17.3%(29/168)、14.9%(25/168)(P=0.388、0.272、0.000)。結(jié)論初步結(jié)果提示IMRT聯(lián)合化療的基礎(chǔ)上加用靶向治療對(duì)提高局部晚期鼻咽癌患者OS、LFFS及DMFS的療效不明顯,且有可能加重放化療相關(guān)的口腔黏膜反應(yīng)。
[Abstract]:Objective a retrospective analysis of IMRT concurrent chemoradiotherapy compared with IMRT concurrent chemoradiotherapy and adjuvant chemotherapy in local advanced nasopharyngeal carcinoma, and to evaluate the efficacy and toxic side effects of two non comprehensive treatment modes in the treatment of locally advanced nasopharyngeal carcinoma. Methods collected from January 2007 to December 2014 at the Affiliated Cancer Hospital of Guangxi Medical University. 797 patients with phase II IV B of nasopharyngeal carcinoma in the radiotherapy department were hospitalized in the radiotherapy department. All the patients were diagnosed as nasopharyngeal carcinoma by pathological diagnosis, including 261 cases of synchronous radiotherapy and chemotherapy (group CCRT), 536 cases with concurrent chemo chemotherapy plus adjuvant chemotherapy (group CCRT+AC). The two groups of data were matched by 1:1, and the survival analysis was obtained by the new sample. Kaplan-Meier method was used. The total survival rate (OS) was calculated, no local recurrence rate (LFFS), no distant metastasis rate (DMFS), and Log-rank test and Cox model were used to analyze the prognostic factors. After matching, 261 cases were matched successfully in group CCRT and CCRT+AC, and 522 patients died in the group, including 14 cases in CCRT group, 18 in CCRT+AC group, and 20 cases recurred. There were 6 cases in group CCRT, 14 in group CCRT+AC, 42 in group CCRT, 14 in group CCRT, 97.9% in group.CCRT in group CCRT+AC, 96.2% and 86.9%, respectively, 100%, 96.5%, 96.5%, respectively, 1,2,3 year DMFS rate respectively, 97.4%, 92.8%, 89%, respectively. The annual LFFS rate was 99.2%, 95.6%, 93.2%, and the rate of DMFS in 1,2,3 was 95.3%, 91.8%, and 87.2%. two, respectively (x 2=2.072, P=0.150; X 2=0.363, P=0.547; X 2=0.875, P=0.350). The subgroup analysis showed that adjuvant chemotherapy after concurrent chemo chemotherapy could significantly improve the survival (P=0.00) for T4 nasopharyngeal carcinoma (P=0.00). 1) the incidence of grade 3-4 acute gastrointestinal tract reaction in.CCRT group was 3.1% (8/261), 21.5 (56/261), 12.3% (32/261), while CCRT+AC group was 3.1% (8/261), 26.8 (70/261), 11.5% (30/261), and there was no statistical difference between the two groups (P=1.000, P=0.152, P=0.787). The total survival rate, no local recurrence rate and no distant metastasis rate are not significantly increased with adjuvant chemotherapy after concurrent chemoradiotherapy, but it is possible to improve the total survival rate for patients with T4 nasopharyngeal carcinoma, but need longer follow-up time and more research to verify. Objective a retrospective comparison of the efficacy and adverse reactions of IMRT combined with chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC), and the necessity of using targeted drugs on the basis of radiotherapy and chemotherapy. Methods to collect the nose of stage III to IV B with IMRT combined chemotherapy plus chemotherapy plus chemotherapy plus targeted therapy for 2007 to 2014. 42 cases of pharynx cancer (test group), the patients with only IMRT combined chemotherapy plus chemotherapy plus chemotherapy and adjuvant chemotherapy were compared with the 1: 4 pairs (control group) 168 cases (control group) and the.Kaplan-Meie R method was used to calculate the survival rate and the difference of Logrank test. The residual rate was 100%, the test group was 42 and 168, respectively, and the experimental group was 3 years OS, LRF. S, the rate of DMFS was 94%, 100%, 92% respectively. The control group was 87.3%, 94.6%, 89.1% (P=0.647,0.193,0.744).3 - 4 gastrointestinal adverse reactions, and the incidence of bone marrow suppression and oral mucosa reaction was 7% (3/42), 26% (11/42), 41% (17/42), and the control group was 3.6% (6/168), 17.3% (29/168), 14.9% (25/168) (P=0.388,0.272,0.000). The preliminary results suggest that the therapeutic effect of IMRT combined with targeted therapy on the improvement of OS, LFFS and DMFS in patients with locally advanced nasopharyngeal carcinoma is not obvious, and it is possible to replay the oral mucosal response related to the replay of chemotherapy.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R739.63

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