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目的探讨后程加速超分割放疗加紫杉醇治疗局部晚期鼻咽癌的近期疗效和毒副反应。方法2005年3月至2008年7月,应用后程加速超分割放疗加紫杉醇治疗局部晚期鼻咽癌36例。放射治疗先期采用60Co机面颈联合野加下半颈前切线野常规分割照射至上颈髓36Gy后,鼻咽部改为耳前野后程加速超分割照射,DT1.5Gy/F,2次/天(间隔6h),10次/W,鼻咽部总剂量69Gy/6W/42F,少数为70～72Gy。后程加速超分割照射的同时每周给予紫杉醇60mg静脉滴注,共3周。观察综合治疗的近期疗效和毒副反应。结果放疗结束时和放疗结束后3个月鼻咽部原发病灶CR率分别为94.4%、97.2%;颈部转移灶CR率分别为91.7%、94.4%。近期毒副反应主要为急性口腔黏膜炎和白细胞下降,经支持对症处理患者均可耐受,全部病例均按时完成治疗计划。结论后程加速超分割放疗加紫杉醇治疗局部晚期鼻咽癌近期疗效好、毒副反应适中,患者易于耐受。远期疗效和毒副反应有待临床进一步研究。
Objective To investigate the short-term effect and toxicity of late-course accelerated hyperfractionation radiotherapy and paclitaxel in the treatment of locally advanced nasopharyngeal carcinoma. Methods March 2005 to July 2008, the application of late-accelerated hyperfraction radiotherapy plus paclitaxel in the treatment of locally advanced nasopharyngeal carcinoma in 36 cases. Radiotherapy early use of 60Co machine neck joint wild plus half of the anterior cervical incision under the line of conventional radiotherapy to the upper cervical 36Gy, nasopharyngeal to the ear before the field after accelerated hyperfractionation, DT1.5Gy / F, 2 times / day (Interval 6h), 10 times / W, the total dose of nasopharyngeal 69Gy / 6W / 42F, a few of 70 ~ 72Gy. Accelerated hyperfractionation after the course of irradiation given paclitaxel 60mg weekly intravenous infusion for a total of 3 weeks. Observation of comprehensive treatment of the recent efficacy and toxicity. Results At the end of radiotherapy and 3 months after radiotherapy, the nasopharyngeal primary lesions CR rates were 94.4% and 97.2%, respectively. The CR rates of cervical metastases were 91.7% and 94.4%, respectively. Recent toxic side effects are mainly acute oral mucositis and leukopenia, symptomatic treatment of patients with support can be tolerated, all cases were completed on time treatment plan. Conclusions Late course accelerated hyperfractionated radiotherapy plus paclitaxel in the treatment of locally advanced nasopharyngeal carcinoma has good curative effect in the near future and moderate toxicities and side effects. Patients are easily tolerated. Long-term efficacy and toxicity need further clinical study.