目的 探析化疗联合调强放疗（IMRT）治疗老年（≥65岁）局部晚期鼻咽癌的临床效果。方法 选取2018年1月—2019年1月我院诊治的90例老年局部晚期鼻咽癌患者为研究对象,使用随机数表法将此90例患者分为观察组及对照组,各45例。观察组行IMRT,对照组行化疗联合IMRT,对比2组的效果。结果 2组的治疗总有效率均为100%,组间差异不显著（P<0.05）。观察组的生活质量改善率（93.33%）高于对照组（77.78%）（P<0.05）。对照组出现3~4级白细胞减少、呕吐、黏膜炎人数明显高于观察组（P<0.05）,两者其他毒副反应比较无显著差异（P>0.05）。观察组的1年总体生存率（91.11%）及3年总体生存率（75.56%）均高于对照组（86.67%、68.89%）（P<0.05）。结论 对于老年局部晚期鼻咽癌,化疗联合IMRT相比单纯IMRT降低了远期生存率,增加了毒副反应并影响疗后生活质量的改善,不宜常规应用,单纯IMRT可能是更合适的治疗选择。

Objective To explore the clinical effect of chemotherapy combined with intensity modulated radiation therapy（IMRT）in the treatment of elderly（≥65 years old）locally advanced nasopharyngeal carcinoma．Methods The study was carried out from January 2018 to January 2019．During this period,90 elderly patients with locally advanced nasopharyngeal carcinoma who were diagnosed and treated in our hospital were selected as the research objects．The random number table method was used to divide the 90 patients into observation groups,and the control group,each with 45 cases．The observation group was treated with IMRT,and the control group was treated with chemotherapy combined with IMRT．The effects of the two groups were compared．Results The total effective rate of the two groups was 100%,and there was no significant difference between the two groups（P<0.05）．The improvement rate of quality of life in the observation group（93.33%）was higher than that in the control group（77.78%,P<0.05）．The number of grade 3-4 leukopenia,vomiting and mucositis in the control group was significantly higher than that in the observation group（P<0.05）,and there was no significant difference in other side effects between the two groups（P>0.05）．The 1-year overall survival rate（91.11%）and 3-year overall survival rate（75.56%）of the observation group were higher than those of the control group（86.67%,68.89%,P<0.05）．Conclusions For locally advanced nasopharyngeal carcinoma in the elderly,chemotherapy combined with IMRT reduces the long-term survival rate,increases the toxic and side effects and affects the improvement of the quality of life after treatment．It is not suitable for routine application,and IMRT alone may be a more appropriate treatment choice.

目的 研究自适应调强放疗(ART)同步铂类化疗治疗局部晚期宫颈癌患者的可行性。方法 选取我院诊治的92例局部晚期宫颈癌患者,随机分为研究组与对照组各46例,其中对照组行调强放疗(IMRT)同步铂类化疗,研究组行ART同步铂类化疗。治疗8周后,比较2组患者临床疗效;于治疗前后比较2组患者肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)]水平;以急性放射损伤分级标准(RTOG)和常见不良反应事件评价标准(CTCAE)比较2组患者不良反应发生情况。结果 治疗8周后,研究组客观缓解率高于对照组(P＜0.05);2组患者CEA、SCC-Ag水平均较治疗前降低,且研究组低于对照组 (P＜0.05);研究组基于RTOG的消化道反应等级与泌尿系统反应等级均低于对照组(P＜0.05);2组患者基于CTCAE的肝功能损害与皮疹评级相比,差异无统计学意义(P＞0.05)。结论 ART同步铂类化疗治疗局部晚期宫颈癌患者疗效较好,使患者病情好转,同时安全性突出,切实可行。

Objective To study the feasibility of adaptive radiotherapy (ART) combined with platinum chemotherapy in the treatment of locally advanced cervical cancer. Methods A total of 92 patients with locally advanced cervical cancer treated in our hospital were randomly divided into study group and control group, with 46 cases in each group. The control group received intensity-modulated radiation therapy (IMRT) combined with platinum chemotherapy and the study group received ART combined with platinum chemotherapy. After 8 weeks of treatment, the clinical effects of the two groups were compared. The levels of tumor markers [carcinoembryonic antigen (CEA) and squamous cell carcinoma associated antigen (SCC-Ag)] were compared between the two groups before and after treatment. The incidence of adverse reactions in the two groups was compared with the grading standard of Acute Radiation Injury Group (RTOG) and Common Terminology Criteria for Adverse Events (CTCAE). Results After 8 weeks of treatment, the Objective remission rate in the study group was higher than that in the control group (P<0.05). The levels of CEA and SCC-Ag in the study group were significantly lower than those in the control group (P<0.05). The reaction grades of digestive tract and urinary system based on RTOG in the study group were significantly lower than those in the control group (P<0.05). There was no significant difference in CTCAE based liver function impairment and rash rating between the two groups (P> 0.05). Conclusions ART combined with platinum chemotherapy is effective and safe in the treatment of locally advanced cervical cancer.

目的 评价调强放疗后颞颌关节损伤的鼻咽癌患者的生存情况。方法 2010年2月—2013年11月期间90例经调强放疗后出现颞颌关节损伤的鼻咽癌患者,鼻咽病灶放疗剂量70～74Gy/32～33f,转移淋巴结放疗剂量64～70Gy/32～33f,高危区预防性放疗剂量58～66Gy/32～33f,低危区预防性放疗剂量54～58Gy/32～33f,采用顺铂、奈达铂或多西他赛行同步化疗。回顾性分析患者的张口困难程度、近期疗效、无局部复发生存、无远处转移生存及总生存情况,同时评价放疗毒副反应。结果 ①颞颌关节损伤:97.8%的患者为Ⅰ级损伤,2.2%的患者为Ⅱ级损伤,无Ⅲ~Ⅳ级重度放射性损伤;②近期疗效:完全缓解67例(74.5%),部分缓解21例(23.3%),稳定1例(1.1%),进展1例(1.1%),总有效率(ORR)为97.8%(88/90),疾病控制率(DCR)为98.9%。③生存情况:中位随访时间57个月(5～84个月),5年无局部复发生存率、无远处转移生存率和总生存率分别为85.6%、71.1%和73.3%。④不良反应:3~4度不良反应有白细胞减少(发生率为24.4%)、中性粒细胞减少(发生率为21.1%)和血小板减少(发生率为1.1%)等血液学毒性以及口腔黏膜炎(发生率为43.3%)、呕吐(发生率为1.1%)和放射性皮炎(发生率为3.3%)等非血液学毒性。结论 鼻咽癌调强放疗后颞颌关节损伤以I度为主;调强放疗后出现颞颌关节损伤的鼻咽癌患者以T3~T4为主,但仍可获得较满意的局控率、较低的远处转移率和较高的总生存率,且安全性较高。

目的 研究PF诱导化疗联合调强放疗及二维放疗对鼻咽癌近远期疗效影响的回顾性分析。方法 回顾性分析2008年1月—2008年12月中山大学附属肿瘤医院收治的101例鼻咽癌患者治疗情况,按照治疗方案技术分为调强组(n=42)和二维组(n=59)。比较两组患者临床疗效,近期毒副反应及生存情况。结果 放疗结束时调强组患者总缓解率92.86%与二维组77.97%比较差异有统计学意义(P<0.05)。调强组Ⅲ-Ⅳ级胃肠道反应26.19%及黏膜炎14.29%发生率与二维组比较显著较少,差异有统计学意义(P<0.05)。两组患者远期毒副反应及生存率比较无显著差异(P>0.05)。结论 PF诱导化疗联合调强放疗治疗鼻咽癌患者,近远期临床疗效好,毒副反应少。

Objective To study the effects of PF induced chemotherapy combined with intensity modulated radiation therapy and two-dimensional radiotherapy on the short and long term curative effects in nasopharyngeal carcinoma. Methods The treatment condition of 101 cases of patients with nasopharyngeal carcinoma who were treated in the Tumor Hospital Affiliated to San Yat-sen University between January and December 2008 were retrospectively analyzed. According to different treatments, the cases were divided into the intensity modulated group and the two-dimensional group. The clinical curative effects, short-term toxic and side effects and survival status were compared between the two groups. Results At the end of radiotherapy, the total remission rate in the intensity modulated group was 92.86% while in the two-dimensional group was 77.97% (P<0.05). In the intensity modulated group, the incidence rates of grade Ⅲ-Ⅳgastrointestinal tract reactions (26.19%) and mucositis (14.29%) were significantly lower than those in the two-dimensional group (P<0.05). There was no significant difference in long-term side effects and survival rate between the two groups (P>0.05). Conclusion PF induced chemotherapy combined with intensity modulated radiation therapy in the treatment of patients with nasopharyngeal carcinoma has good short and long-term curative effects and few toxic and side effects.