局部晚期鼻咽癌放射治疗的研究进展_徐瑾

〖综述·讲座〗局部晚期鼻咽癌放射治疗的研究进展

徐瑾,　郝俊芳

山东省肿瘤医院放疗科,山东济南250117

Progress in the treatment of local advanced nasopharyngeal carcinoma

XU J in,H AO J un-f ang

Department of Radiation Oncology,Shandong Cancer Hospital,J inan250117,P.R.China

【摘要】　目的:分析局部晚期鼻咽癌治疗的国内外研究现状和进展,为临床治疗提供依据。方法:应用P ubM ed和CN K I等数据检索系统及数据库,以“鼻咽肿瘤和放射治疗”等为关键词检索2000-01-2010-06的相关文献,纳入标准:1)鼻咽癌治疗的临床试验,包括方法、结果和进展;2)鼻咽癌放疗、化疗及其他治疗的疗效及不良反应。根据纳入标准符合分析的文献27篇。结果:各种治疗方法的临床研究均取得了一定的进展,其中调强放疗的应用使局部晚期鼻咽癌的局部控制率>90%,且使得放疗的急慢性不良反应较常规放疗明显减轻,但同时也对靶区的确定和勾画提出了更为严格的要求。联合化疗在提高总生存率及降低远处转移率方面是有意义的,其中同步放化疗的疗效最为显著。靶向药物的应用为鼻咽癌的治疗提供了新的方向,是目前研究的热点,但需要进一步的临床试验。结论:局部晚期鼻咽癌在治疗上仍以放射治疗为主,联合同步化疗或与靶向药物结合都取得了较为有效的作用。

中华肿瘤防治杂志,2011,18(2):156-160[ABSTRAC T]　OBJECTIVE:T o summarized the recent pro g ress in the treatment of local adv anced nasopha ryng ea l ca rcinoma.METHODS: T he PubM ed system and CN KI da tabases w ere sear ched using the key-wo rds nasophary ng eal carcino ma and the rapy,published fr om Jan. 2000to Jun.2010.Criteria o f paper adoptio n:1)Clinical study of na-so phar yngeal carcino ma including the methods,r esult,and prog res-ses;2)Analy sis the efficacy,side effects o f radio ther apy,chemo ther-apy and o ther the rapies.A cco rding to the above criteria,27pape rs we re finally selected fo r analy zed and reviewed.RESULTS:All o f these different the rapies make some improv ement.A nd most of resear-ches focus o n the intensity mo dulated r adia tion therapy(IM R T),IM-RT brings local co ntro l rates up to mo re than90%and obvio usly de-crease s the side effects compared with the co nv entional radio ther apy with better sparing of the surro unded normal tissue,w hile IM RT need mo re strictly request fo r the tar get coutour ed.Co mbine chemo ther apy with radio the rapy can reduce the metastasis rate and improv e the ov er-all survival(OS),and co ncurr ent chemo-r adio therapy is the mo st promising stra teg y to co pe w ith the disease.T arg et the rapy has be-co me an impo rtant new t reatment o ption;how ev er,the re need fur ther clinical research to co nfirm their effect.C ONCLUSION:A t present ra-dio therapy is still the main me thod in the treatment of lo co-reg io nally adv anced nasopha ryngea l ca rcino ma,combined with concur rent chemo-the rapy o r targ et therapy also have sho w n g reat effect.

Ch in J Cancer Pr ev Treat,2011,18(2):156-160

【关键词】　鼻咽肿瘤/放射治疗;综合疗法;综述文献

[KEYWORDS]　nasopha ryng ea l neoplasms/r adio therapy;co mbined modality therapy;rev iew lite rature 【中图分类号】　R739.6 【文献标识码】　A 【文章编号】　1673-5269(2011)02-0156-05

鼻咽癌作为一种放射敏感的肿瘤,在治疗上首选放疗,而失败的主要原因仍为局部复发和远处转移。

【第一作者简介】　徐瑾,女,山东淄博人,硕士,主要从事肿瘤放疗的研究工作。

T el:86-531-67626152　E-mail:iamx ujincn@y 【通讯作者简介】　郝俊芳,女,山东聊城人,研究员,硕士生导师,主要从事肿瘤放疗的研究工作。

T el:86-531-67626151　E-mail:hao-j-f@163.co m Yi等[1]分析了905例行根治性放疗的鼻咽癌患者,其中首次失败局部未控率占40.9%,远处转移占49.0%。而在长期生存患者中存在着不同程度的放疗晚期不良反应[1-2]。因此,如何进一步提高鼻咽癌患者的局部控制率,降低正常组织并发症的发生率,成为治疗的目标。近年来,随着放射技术进步以及放化综合治疗的临床应用,局部晚期鼻咽癌的治疗取得了较以前更为满意的局部控制率和总生存率。