放化疗联合热疗治疗鼻咽癌颈部淋巴结转移33例疗效分析

放化疗联合热疗治疗鼻咽癌颈部淋巴结转移33例疗效分析发表时间：2014-01-23T10:14:44.607Z 来源：《中外健康文摘》2013年第34期供稿作者：韦祝新阮林（通信作者）王仁生康敏丁华姚樱之

[导读] Zhuxin Wei, LinRuan, Rensheng Wang, Min Kang, Hua Ding, Yingzhi YAO 韦祝新阮林（通信作者）王仁生康敏丁华姚樱之（广西医科大学第一附属医院放疗科 530021）【摘要】目的评价放化疗联合热疗治疗鼻咽癌颈部淋巴结转移的临床疗效。方法选取2006年-2007年我院收治的鼻咽癌伴颈部淋巴结转移二程诱导化疗后有淋巴结残留的患者33例。诱导化疗采用顺铂联合5-氟尿嘧啶化疗，每3周一次，共2次。诱导化疗后有残留的随机分为观察组和对照组。其中对照组17例，用单药顺铂联合常规放疗，观察组16例，放化疗措施同对照组，放疗前对病灶给予局部热疗。观察并比较两组患者颈部淋巴结消退情况、治疗后生存率及放化疗毒性反应。结果观察组采用放化疗联合热疗，总有效率为100%，对照组采用单纯放化疗治疗，总有效率为88.23%，相比较差异有统计学意义(P＜0.05)；观察组治疗后3年生存率(81.25%)及5年的生存率(56.25%)与对照组治疗后3年的生存率(64.71%)及5年的生存率(41.18%)相比较差异有统计学意义，P＜0.05；观察组不良反应发生率为6.25%，对照组不良反应发生率为11.8%，相比较差异无统计学意义(P＜0.05)。结论放化疗联合热疗治疗鼻咽癌颈部淋巴结转移疗效好，值得在临床上予以推广。

【关键词】放疗热疗鼻咽癌疗效【中图分类号】R730.53 【文献标识码】A 【文章编号】1672-5085（2013）34-0055-02 Chemotherapy combined with hyperthermia treatment of metastatic cervical lymph node metastasis efficacy analysis of 33 cases Zhuxin Wei, LinRuan, Rensheng Wang, Min Kang, Hua Ding, Yingzhi YAO First Affiliated Hospital of Guangxi Medical University, Department of Radiation Oncology 530021 【Abstract】 Objective : To evaluate chemotherapy combined with hyperthermia treatment of metastatic cervical lymph node metastasis in clinical efficacy. Methods: 2006 to 2007 in our hospital nasopharyngeal carcinoma with cervical lymph node metastasis in patients with residual two -way 33 patients after induction chemotherapy. Induction chemotherapy using cisplatin in combination with 5 -fluorouracil chemotherapy once every three weeks , a total of 2 times. After induction chemotherapy were randomly divided into observation residual group and the control group . Among the control group 17 cases , with single-agent cisplatin conventional radiotherapy , the observation group 16 cases , chemotherapy measures with the control group , given before radiotherapy for lesions localized hyperthermia. Comparison of the two groups were observed and regression of cervical lymph nodes , survival and toxicity after chemotherapy treatment . Results: The study group using chemotherapy combined with hyperthermia , the total effective rate was 100 % in the control group were treated with radiotherapy and chemotherapy alone , the total effective rate was 88.23% , compared to the difference was statistically significant (P <0.05); observation group after treatment 3 -year survival rate ( 81.25% ) and 5-year survival rate ( 56.25% ) after treatment with the control group, 3 -year survival rate ( 64.71% ) and 5-year survival rate ( 41.18% ) compared to the difference was statistically significant , P <0.05; adverse reactions observed group was 6.25 % in the control group of adverse reactions was 11.8% , compared with no significant difference (P <0.05). Conclusion: chemotherapy combined with hyperthermia therapy is effective cervical lymph node metastasis of nasopharyngeal carcinoma deserves to be promoted in clinical practice. 【Keywords】 radiotherapy hyperthermia nasopharyngeal carcinoma efficacy 鼻咽癌患者初治时伴颈部淋巴结转移者可达70%[1]，治疗后颈部淋巴结残留和复发仍是影响患者生存率的重要影响因素。近年来，我院通过对收治的病人进行分组研究，探讨放化疗联合热疗治疗鼻咽癌伴颈部淋巴结转移的疗效，取得了较好的效果，报道如下。

1 资料与方法

1.1 一般资料选取2006年-2007年我院收治的行二程PF方案化疗后仍有淋巴结33例鼻咽癌并颈部淋巴结转移的患者，均为N2-N3期，观察组16例，男10例，女6例，年龄18-69岁，平均47岁，其中未分化非角化性癌14例，分化型非角化性癌2例；对照组17例，男11例，女6例，年龄20-70岁，平均46岁，未分化非角化性癌15例，分化型非角化性癌2例。两组患者在年龄、性别、病程、分期等一般资料无统计学差异，具有可比性。

1.2 方法对照组：诱导化疗采用顺铂联合5-氟尿嘧啶联合化疗2周期，其中顺铂80mg/m2分2d静脉滴注，5-氟尿嘧啶750mg/m2，d1-d5，静注，21d为1周期；二程诱导化疗结束后21天仍有淋巴结残留者随机分为观察组及对照组，开始行同期放化疗，放疗用CT-sim方式，剂量2Gy/次，1次/d，5d/周。原发灶先采用6mV X线面颈联合照射DT36Gy，结束后改用耳前照射DT40Gy，鼻咽部总照射剂量为DT75-78Gy、35-40次，47-50d。颈部淋巴结转移病灶采用6mV X线照射达50Gy后，改用9-12mV线照射至DT68-72Gy、35-36次、45-50d，预防剂量为DT50-55Gy。同期化疗用单药顺铂80mg/m2分2d静脉滴注，每21天一周期，共3周期。观察组：放化疗用法同对照组，颈部淋巴结转移病灶于放疗第二天起配合局部热疗，采用915MHz高能聚束微波热疗机UHR-2000，根据肿瘤具体大小采用不同型号辐射器，辐射器距离体表2-5cm，热疗部分皮肤用水袋降温。对肿瘤表面皮肤监测，控制温度41.5-4

2.0℃，热疗后1h内行放疗。有效加温时间每次45min，2次/周，共8-12次，或淋巴结完全消退。

1.3 观察指标观察并比较两组患者颈部淋巴结消退情况、治疗后生存率及放化疗毒性反应。

1.4 疗效评价标准按照WHO实体瘤评价标准，分为完全缓解、部分缓解、无改变。疗程结束后评价颈部淋巴结消退情况，肿瘤完全消退者为完全缓解，肿瘤缩小二分之一以上为部分缓解，总有效率=完全缓解率+部分缓解率[2-3]。

1.5 统计学方法采用SPSS17.0统计软件进行分析，计量资料用均数±标准差形式表示，组间比用t检验，率用卡方检验，当P＜0.05为差异有统计学意义。

2 结果

2.1 颈部淋巴结消退情况比较观察组采用放化疗联合热疗，总有效率为100%，对照组采用单纯放化疗治疗，总有效率为88.23%，相比较差异有统计学意义，P＜0.05。具体见表1。表1 两组患者颈部淋巴结消退情况比较