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1、化放疗与单放疗治疗Ⅲ，Ⅳa期鼻咽癌远期疗效的比较陆小军，雷风，吴新光，叶亦菁，刘玉猛，何伟基，周锡刚，王得坤【关键词】鼻咽肿瘤/药物疗法,放射疗法；治疗结果 parisonofthelongtermeffectsofchemoradiotherapyandradiotherapyaloneforpatientsa 【Abstract】AIM:Tostudyandparethelongtermeffectsofchemoradiotherapyandradiotherapyaloneinthetreatmentofnasopharyngealcar
2、cinoma(NPC).METHODS:Atotalof180patientslydividedintochemotherapyplusradiotherapygroup(CT/RTgroup)andradiotherapyalonegroup(RTgroup).CisplatinbasedinductionchemotherapyedinCT/RTgroupfor2cycle(DFP,TFP,in47cases;PF,PFB,EFPin43cases)andradiotherapyotherapy.Themethodsofradiationeinb
3、othgroups.RESULTS:Thedistantmetastasisfreesurvival(DMFS)ratesin3and5yearsotherapyprojectincludingpaclitaxelsuchasDFP,TFPoreexcellentthanclassicalchemotherapyprojectssuchasFP,FBP,EFP(3,5yearDMFS:P=0.019,P=0.022).TheacuteoralmucositisofⅢ,Ⅳdegreeandleucopeniaintheformergroupsuchmo
4、reseverethanthoseinthelattergroups(51.1%vs30.2%,P=0.018;34.0%vs14.0%,P=0.07).ButtheseadverseeactionscanbetolerablebyusingGCSF.Thereent.Nopatientsneedtodecreasethedoseofchemotherapyorradiationortoterminatethetreatment,ortodelaythelateradiotherapy.CONCLUSION:Thechemoradiotherapyc
5、andecreasesignificantlytherateofdistantmetastasisasparedotherapyprojectincludingpaclitaxelsuchasDFP,TFPismoreexcellentthanclassicalchemotherapyprojectssuchasFP,FBP,EFP,butacuteoralmucositis(GradeⅢofⅣ)andleucopeniaintheformergroupsuchmoreseverethanthoseinthelattergroups.Theadver
6、sereactionscanbetolerablebyusingGCSF. 【Keys/drugtherapy,radiotherapy;treatmentoute 【摘要】目的：比较诱导化疗综合放疗与单纯放疗对局部晚期鼻咽癌远期生存的影响.方法：病理确诊的Ⅲ，Ⅳa期鼻咽癌180例随机均分为化放组和单放组，化放组用含Cisplatin为主的联合方案诱导化疗2个疗程后1o；血常规、肝肾功能正常.按照随机分组原则分别进入单纯放疗组（简称单放组）和诱导化疗综合放射组（简称化放组），各90例接受治疗.两组资料具有可比性（P＞0.05）. 1.2方法
7、1.2.1放射治疗采用60COγ射线进行连续放射治疗.根据CT扫描图像在定位片上进行放射野设置，并在模拟机上摆位验证，用铅挡块保护靶区正常组织.放射治疗第1段采取双侧面颈联合野+下颈前野照射36Gy；第2段依据口咽和颈淋巴结的受累情况，改用双侧耳前野照射34Gy，颈前野照射14~24Gy；或将面颈联合野后界前移避开脊髓照射14~24Gy，后颈部用电子线野补量14~24Gy后，再改为双侧耳前野照射10~20Gy.时间剂量分割方式为2Gy，1次/d，5次/eier法，生存曲线比较采用LogRank检验法，余为t检验.预后及不良反应评价采用RFS和DMFS
8、两组预后评价指标统计.计算生存时间以放疗开始，在随访期内无复发生存率以出现复发为终点，未出现复发为终检值；无
