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

【摘要】：第一部分新輔助化療聯(lián)合同步放化療對(duì)比單純同步放化療治療鼻咽癌的遠(yuǎn)期療效觀察目的新輔助化療+同步化療能否改善鼻咽癌患者生存預(yù)后仍存在爭(zhēng)議。本研究旨在研究新輔助化療在鼻咽癌治療中的作用。方法對(duì)我院2006.12-2012.12共255例經(jīng)病理確診、初治無(wú)遠(yuǎn)處轉(zhuǎn)移、接受了新輔助化療聯(lián)合同步放化療或單純同步放化療的鼻咽癌患者進(jìn)行回顧性研究,放療技術(shù)均為調(diào)強(qiáng)放療。其中,接受新輔助化療+同步化療組(NCT組)67例,單純同步化療組(CRT組)188例。為控制組間不平衡及混雜偏倚,以年齡、性別、KPS評(píng)分、T-、N-及臨床分期、WHO分型、同步化療方案8個(gè)變量建模,使用傾向性得分匹配對(duì)其進(jìn)行1:2配對(duì),成功配對(duì)后新輔助化療組(NCT組)67例,單純同步化療組(CRT組)134例,對(duì)成功匹配后兩組病例的遠(yuǎn)期療效及毒性反應(yīng)等進(jìn)行對(duì)比研究分析。結(jié)果本研究新輔助化療組(NCT組)中位隨訪時(shí)間49月(11~105月),單純同步化療組(CRT組)為48月(8~109月)。NCT組、CRT組5年總生存率(OS)分別為78.8%vs.79.5%(p=0.305);5年無(wú)進(jìn)展生存率(PFS)分別為69.1%vs 75.7%(p=0.448),5年無(wú)復(fù)發(fā)生存率(RFS)分別為90.0%vs.92.7%(p=0.790),5年無(wú)局部復(fù)發(fā)生存率(LRFS)分別為90.0%vs.94.2%(p=0.512),5年無(wú)區(qū)域復(fù)發(fā)生存率(RRFS)分別為100%vs.96.1%(p=0.104),5年無(wú)遠(yuǎn)處轉(zhuǎn)移生存率(DFFS)分別為78.3%vs.82.7%(p=0.671)。全組病例多因素分析結(jié)果示治療方式(NCT vs.CRT)對(duì)OS、PFS、RFS、LRFS、RRFS及DFFS無(wú)明顯差別(p=0.627、0.879,0.760,0.847,0.969及0.774);全組接受同步化療≥2周期者獲得更好的OS、RFS及DFFS(p=0.009、0.016及0.043)。本研究中PF或TPF對(duì)比其他不同新輔助化療方案并無(wú)明顯優(yōu)勢(shì)(OS、PFS、LRFS及DFFS的p值分別為0.321、0.254、0.380及0.304)。兩組間急性和晚期毒副反應(yīng)發(fā)生率無(wú)明顯差異。結(jié)論新輔助聯(lián)合同步放化療對(duì)比單純同步放化療在鼻咽癌治療中遠(yuǎn)期療效相當(dāng),其毒性范圍可控。新輔助化療在鼻咽癌治療中的作用及地位仍需進(jìn)一步研究。第二部分初治鼻咽癌調(diào)強(qiáng)放療后復(fù)發(fā)情況及復(fù)發(fā)因素目的研究鼻咽癌調(diào)強(qiáng)放療后的復(fù)發(fā)情況,探討其復(fù)發(fā)因素。方法回顧性分析我院2006.09-2012.09 720例經(jīng)病理確診、初治無(wú)遠(yuǎn)處轉(zhuǎn)移的鼻咽癌根治性IMRT后情況,研究其總生存率(OS)、無(wú)進(jìn)展生存率(PFS)、無(wú)復(fù)發(fā)生存率(RFS)、無(wú)局部復(fù)發(fā)生存率(LRFS)、無(wú)區(qū)域復(fù)發(fā)生存率(RRFS)及無(wú)遠(yuǎn)處轉(zhuǎn)移生存率(DFFS),主要分析其復(fù)發(fā)情況及復(fù)發(fā)因素。結(jié)果全組中位隨訪時(shí)間為53個(gè)月(8~109個(gè)月)。5年總生存率(OS)、無(wú)進(jìn)展生存率(PFS)、無(wú)復(fù)發(fā)生存率(RFS)、無(wú)局部復(fù)發(fā)生存率(LRFS)、無(wú)區(qū)域復(fù)發(fā)生存率(RRFS)及無(wú)遠(yuǎn)處轉(zhuǎn)移生存率(DFFS)分別為79.9%、73.8%、91.4%、93.1%、96.7%及85.8%。全組共60例鼻咽癌放療后出現(xiàn)復(fù)發(fā),其中單純局部復(fù)發(fā)36例,單純區(qū)域復(fù)發(fā)12例,局部+區(qū)域復(fù)發(fā)10例,局部殘留復(fù)發(fā)1例,區(qū)域殘留復(fù)發(fā)1例。其中位復(fù)發(fā)時(shí)間為22個(gè)月(3-82月)。多因素分析結(jié)果顯示,年齡為≥44歲為局部復(fù)發(fā)的危險(xiǎn)預(yù)后因素(p=0.030),T-、N-、臨床分期等均非復(fù)發(fā)相關(guān)因素(p均大于0.05)。結(jié)論初治鼻咽癌調(diào)強(qiáng)放療后取得較好的局部區(qū)域控制,但仍存在復(fù)發(fā)失敗模式,以3年內(nèi)復(fù)發(fā)最為常見(jiàn)。年齡≥44歲為鼻咽癌根治性IMRT后復(fù)發(fā)危險(xiǎn)因素。如何降低鼻咽癌放療后復(fù)發(fā),仍需進(jìn)一步研究。第三部分調(diào)強(qiáng)放療后復(fù)發(fā)鼻咽癌挽救性調(diào)強(qiáng)放療的安全性及療效目的初步評(píng)估鼻咽癌調(diào)強(qiáng)放療后復(fù)發(fā)挽救性IMRT的安全性、可行性及有效性。方法第二部分所述的復(fù)發(fā)鼻咽癌中,23例于我院接受了調(diào)強(qiáng)放療為主的挽救性治療,以復(fù)發(fā)診斷日期為起點(diǎn),研究其總生存率(OS)、無(wú)進(jìn)展生存率(PFS)及無(wú)遠(yuǎn)處轉(zhuǎn)移生存率(DFFS),初步研究放療后復(fù)發(fā)鼻咽癌挽救性調(diào)強(qiáng)放療的療效及相關(guān)并發(fā)癥。結(jié)果鼻咽癌復(fù)發(fā)后中位隨訪時(shí)間為19個(gè)月(2-63月),其1年、2年OS為72.7%、38.2%。本研究中挽救性IMRT的3~4級(jí)毒性反應(yīng)并不常見(jiàn)。1例患者因自身原因完成39.6 Gy放療量后放棄治療,最終死亡。結(jié)論根治性IMRT后復(fù)發(fā)鼻咽癌的挽救性IMRT安全性較高,大部分毒副反應(yīng)可耐受,但遠(yuǎn)期療效較差。如何提高挽救性調(diào)強(qiáng)放療療效,仍需進(jìn)一步研究。
[Abstract]:The first part of the new adjuvant chemotherapy combined with concurrent chemoradiotherapy compared with simple concurrent chemoradiotherapy in the long term effect of nasopharyngeal carcinoma in the treatment of nasopharyngeal carcinoma. Objective new adjuvant chemotherapy plus synchronous chemotherapy can improve the survival of nasopharyngeal carcinoma patients. The purpose of this study is to study the role of neoadjuvant chemotherapy in nasopharyngeal carcinoma treatment. Method to our hospital 2006.12-2012.12 A total of 255 patients were diagnosed with no distant metastasis, and a retrospective study of nasopharyngeal carcinoma patients received neoadjuvant chemotherapy combined with concurrent chemo chemotherapy or simple concurrent chemoradiotherapy was performed. The radiotherapy techniques were all intensity modulated radiation therapy. Among them, 67 cases were treated with neoadjuvant chemotherapy + synchronous chemotherapy group (group NCT) and 188 cases in group CRT alone (group CRT). Balance and mixed bias, with age, sex, KPS score, T-, N- and clinical staging, WHO typing, synchronized chemotherapy 8 variables modeling, using the tendency score matching to carry out 1:2 pairing, 67 cases in the new adjuvant chemotherapy group (group NCT) after successful pairing, 134 cases in the pure synchronous chemotherapy group (group CRT), and the long-term efficacy and toxicity of the successful matched group of two cases. Results the median follow-up time of the new adjuvant chemotherapy group (group NCT) was 49 months (11~105 months), the simple synchronous chemotherapy group (group CRT) was 48 months (8~109 month).NCT group, and the total 5 year survival rate (OS) in the CRT group was 78.8%vs.79.5% (p=0.305), and the 5 year progression free survival rate (PFS) was 69.1%vs 75.7% (p=0.448), and no recurrence in 5 years. The survival rate (RFS) was 90.0%vs.92.7% (p=0.790), and the 5 year non local recurrence survival rate (LRFS) was 90.0%vs.94.2% (p=0.512). The 5 year regional recurrence survival rate (RRFS) was 100%vs.96.1% (p=0.104) respectively, and the 5 year distant metastasis survival rate (DFFS) was 78.3%vs.82.7% (p=0.671). CRT) there were no significant differences in OS, PFS, RFS, LRFS, RRFS and DFFS (p=0.627,0.879,0.760,0.847,0.969 and 0.774). The whole group received better OS, RFS and DFFS (p=0.009,0.016 and 0.043). .254,0.380 and 0.304). There is no significant difference in the incidence of acute and late toxic and side effects among the two groups. Conclusion the therapeutic effect of neoadjuvant combined radiotherapy and chemotherapy on the treatment of nasopharyngeal carcinoma is comparable and its toxicity range is controllable. The role and status of neoadjuvant chemotherapy in the treatment of nasopharyngeal carcinoma still need to be further studied. The second part of the new adjuvant chemotherapy still needs to be studied. To study the recurrence and recurrence factors of nasopharyngeal carcinoma after intensity modulated radiotherapy in order to study the recurrence of nasopharyngeal carcinoma after intensity modulated radiotherapy, and to discuss the recurrence factors. Methods the total survival rate (OS) and no progression survival rate (PFS) were studied in 720 cases of 2006.09-2012.09 in our hospital after the primary treatment of nasopharyngeal carcinoma without distant metastasis. No recurrence survival rate (RFS), no local recurrence survival (LRFS), no regional recurrence survival (RRFS) and distant metastasis survival (DFFS). The recurrence and recurrence factors were mainly analyzed. Results the total median follow-up time was 53 months (8~109 months),.5 total survival rate (OS), no progression survival (PFS), no recurrent survival (RFS), no local relapse. Occurrence rate (LRFS), regional recurrence survival (RRFS) and distant metastasis survival rate (DFFS) were 79.9%, 73.8%, 91.4%, 93.1%, 96.7% and 85.8%., and 60 cases of nasopharyngeal carcinoma were recurred after radiotherapy, including 36 cases with simple local recurrence, 12 recurrent regional recurrence, 10 local region recurrence, 1 local residual recurrence and 1 recurrence of regional residual. The recurrence time was 22 months (3-82 months). The results of multiple factors analysis showed that age was 44 years old as a risk prognostic factor for local recurrence (p=0.030), T-, N-, and clinical staging were all non recurrent factors (P greater than 0.05). Conclusion a better local regional control was taken after the initial treatment of nasopharyngeal carcinoma by intensity modulated radiotherapy, but the recurrence failure mode still existed. The most common recurrence in 3 years. Age more than 44 years old is a risk factor for recurrent nasopharyngeal carcinoma recurrence after radical IMRT. Further study on how to reduce the recurrence of nasopharyngeal carcinoma after radiotherapy is still needed. The safety and efficacy of salvage modulated radiotherapy for recurrent nasopharyngeal carcinoma after intensity modulated radiotherapy (third) is a preliminary assessment of the recurrence and salvage IMRT safety of nasopharyngeal carcinoma after intensive radiotherapy. Total, feasibility and effectiveness. In the second part of recurrent nasopharyngeal carcinoma, 23 cases of recurrent nasopharyngeal carcinoma were treated with intensity modulated radiation therapy in our hospital. The total survival rate (OS), progression free survival (PFS) and distant metastasis rate (DFFS) were studied at the starting point of the recurrence diagnosis. The preliminary study on the salvage modulation of recurrent nasopharyngeal carcinoma after radiotherapy Results the median follow-up time after recurrent nasopharyngeal carcinoma was 19 months (2-63 months), 1 years and 72.7% for 2 years OS. The 3~4 grade toxicity of salvaged IMRT in this study was not common in.1 patients after 39.6 Gy radiotherapy, and finally died. Conclusion the recurrence of nasopharynx after radical IMRT was found. Conclusion the recurrence of nasopharynx after radical IMRT. The rescue IMRT of cancer is highly safe, most of the side effects can be tolerated, but the long-term effect is poor. How to improve the efficacy of salvage intensity modulated radiation therapy still needs further study.

【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
【分類號(hào)】：R739.63

【參考文獻(xiàn)】

中國(guó)期刊全文數(shù)據(jù)庫(kù) 前10條

1 Shaodong Hong;Li Zhang;;Gemcitabine improves survival in patients with recurrent or metastatic nasopharyngeal carcinoma[J];Chinese Journal of Cancer;2016年12期

2 Hai?Yun Wang;Yih?Leong Chang;Ka?Fai To;Jacqueline S.G.Hwang;Hai?Qiang Mai;Yan?Fen Feng;Ellen T.Chang;Chen?Ping Wang;Michael Koon Ming Kam;Shie?Lee Cheah;Ming Lee;Li Gao;Hui?Zhong Zhang;Jie?Hua He;Hao Jiang;Pei?Qing Ma;Xiao?Dong Zhu;Liang Zeng;Chun?Yan Chen;Gang Chen;Ma?Yan Huang;Sha Fu;Qiong Shao;An?Jia Han;Hai?Gang Li;Chun?Kui Shao;Pei?Yu Huang;Chao?Nan Qian;Tai?Xiang Lu;Jin?Tian Li;Weimin Ye;Ingemar Ernberg;Ho Keung Ng;Joseph T.S.Wee;Yi?Xin Zeng;Hans?Olov Adami;Anthony T.C.Chan;Jian?Yong Shao;;A new prognostic histopathologic classification of nasopharyngeal carcinoma[J];Chinese Journal of Cancer;2016年06期

3 Ying Guan;Shuai Liu;Han-Yu Wang;Ying Guo;Wei-Wei Xiao;Chun-Yan Chen;Chong Zhao;Tai-Xiang Lu;Fei Han;;Long-term outcomes of a phase Ⅱ randomized controlled trial comparing intensity-modulated radiotherapy with or without weekly cisplatin for the treatment of locally recurrent nasopharyngeal carcinoma[J];Chinese Journal of Cancer;2016年04期

4 Wen-Ze Qiu;Pei-Yu Huang;Jun-Li Shi;Hai-Qun Xia;Chong Zhao;Ka-Jia Cao;;Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus concurrent chemoradiotherapy plus adjuvant chemotherapy for the treatment of locoregionally advanced nasopharyngeal carcinoma:a retrospective controlled study[J];Chinese Journal of Cancer;2016年01期

5 王羽;陳國(guó)鍵;鄧?yán)麅z;李坊銘;;33例鼻咽癌復(fù)發(fā)的相關(guān)因素分析[J];中國(guó)醫(yī)學(xué)創(chuàng)新;2015年20期

6 吳立洲;王麗君;黃生富;張?zhí)m芳;何俠;張宜勤;;鼻咽癌調(diào)強(qiáng)放療后局部復(fù)發(fā)的臨床分析[J];腫瘤學(xué)雜志;2015年03期

7 田允銘;白力;肖巍魏;曾雷;劉帥;黃劭敏;鄧小武;趙充;盧泰祥;韓非;;局部復(fù)發(fā)鼻咽癌再程IMRT遠(yuǎn)期療效分析[J];中華放射腫瘤學(xué)雜志;2015年02期

8 李齡;高穎川;朱小東;曲頌;梁振強(qiáng);梁霞;付慶國(guó);李文莊;;鼻咽癌調(diào)強(qiáng)放療療效及局部復(fù)發(fā)的劑量學(xué)因素分析[J];腫瘤防治研究;2014年04期

9 鄭寶敏;劉穎;;咽后淋巴結(jié)轉(zhuǎn)移在鼻咽癌調(diào)強(qiáng)放療預(yù)后中的意義[J];中華放射醫(yī)學(xué)與防護(hù)雜志;2014年01期

10 王體兵;王麗君;孔誠(chéng);許建華;黃生富;何俠;張?zhí)m芳;張宜勤;;鼻咽癌調(diào)強(qiáng)放療后頸淋巴結(jié)復(fù)發(fā)的臨床分析[J];腫瘤學(xué)雜志;2013年11期

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