后程加速超分割放疗加同步化疗治疗晚期下咽低分化癌的临床观察

目的比较晚期下咽低分化或未分化癌患者通过常规放射治疗、后程加速超分割放疗加和不加同步化疗的近期疗效和副反应。方法72例晚期低分化或未分化下咽癌患者随机分为三组,即常规放疗(CIR)组、后程加速超分割(AH-FR)组和后程加速超分割加同步化疗(AHFR CC)组。结果三组在放疗半量(36Gy)时下咽病灶有效(PR CR)率分别为54·2%、54·2%和70·8%;颈部转移灶有效(PR CR)率分别为54·2%、54·2%和70·8%;全量放疗结束时下咽病灶完全消退(CR)率分别为66·7%、83·3%和87·5%,CIR组与AHFR CC组比较无明显差异性(P>0·05);颈部转移灶完全消退(CR)率分别为70·8%、83·3%和91·7%,CIR组与AHFR CC组比较无明显差异性(P>0·05);放化疗毒副作用所致恶心呕吐和骨髓抑制等差异有显著性(P<0·05)。结论晚期下咽低分化或未分化癌后程加速超分割放疗加同步化疗较单纯常规放疗疗效好,但毒副作用较重。

Clinical study of concurrent chemotherapy with late-course accelerated hyperfractionation irradiation for advanced hypopharyngeal carcinoma

Objective:To compared the toxicity and effect of conventional irradiation(CIR)and late-course accelerated hyperfractionation irradiation(AHFR)plus or not concomitant chemotherapy(CC)for advanced hypopharyngeal carcinoma(HPC).Methods:From January 2000 to December 2004,72 patients with advanced HPC were randomized into three groups:conventional irradiation alone group(CIR,24 patients);treated by conventional irradiation to a dose of DT 36Gy,then accelerated hyperfractionation irradiation to a total dose of DT 70Gy group(AHFR,24 patients);radiotherapy as the second group,plus concomitant chemotherapy group(AHFR CC,24 patients).Results:All patients completed the treatment.At the dose of DT 36Gy,according to physical and image examination,the CR PR rate of hypophargngeal primary tumor in CIR group,AHFR group,and AHFR CC group were 54.2%,54.2%and 70.8%,respectively.The CR PR rate of neck nodes were 54.2%,54.2%and 70.8%;At the dose of DT 70Gy,the CR rate of primary tumor were 66.7%,83.3%and 87.5% respectively,the CR rate of neck nodes were 70.8%,83.3%and 91.7%.There was significant difference between the three groups in toxicity,such as nausea,vomiting and myelosuppression.Conclusion:Late-course AHFR plus CC for advanced HPC can significantly improve short-term efficacy and local control rates,but it has much toxicity.