【摘要】 目的 觀察時辰化學療法聯合放射治療對比常規化學療法聯合放射治療對鼻咽癌的近期療效及其不良反應。 方法 2006年2月-2010年3月經病理學證實未接受過化學療法的38例晚期鼻咽癌患者隨機分為常規化學療法聯合放射治療組（A組，n=20）和時辰化學療法聯合放射治療組（B組，n=18）。兩組均采用常規二維放射治療。A組化學療法方案為順鉑（DDP）80 mg/m2，采用完全水化方案，第1天靜脈滴注；氟尿嘧啶800 mg/（m2?d），第2~6天120 h連續靜脈滴注。B組時辰化學療法采用Melodies多通道編程輸液泵進行正弦曲線式時間調節給藥。兩組均為DDP 80 mg/m2，于10:00~22:00給藥，濃度高峰設定在16:00；氟尿嘧啶800 mg/m2，于22:00~次日10:00給藥，濃度高峰設定在凌晨4:00。每21天重復1次，行2~6療程。 結果 A組3程化學療法后有效率（PR）為95%（19/20），全程結束完全緩解率（complete remission，CR）達75%（15/20）；B組在2程化學療法后PR達100%，全程治療結束CR達94.4%（17/18）。兩組不良反應主要為遲發性血小板減少，發生率分別為35%（7/20）和22.2%（4/18），其他不良反應兩組間無明顯差別。 結論 時辰化學療法聯合放射治療對晚期鼻咽癌在減輕化學療法造成的血小板減少方面有明顯的優勢，值得臨床推廣應用以及進一步發掘時辰化學療法在臨床治療的價值。【Abstract】 Objective To investigate the efficacy and the adverse effects of routine chemotherapy and chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal cancer patients. Methods From March 2006 to March 2010, 38 patients diagnosed pathologically to have advanced nasopharyngeal cancer were randomly divided to the routine chemotherapy and radiotherapy group (group A, n=20) and the chrono-chemotherapy and radiotherapy group (group B, n=18). Patients in both groups received bi-dimensional radiotherapy. Patients in group A received a full hydration method, cisplatin (DDP) 80 mg/m2 intravenous infusion was also carried out on day 1; fluorouracil 800 mg/(m2?d) chemotherapy, and 120 hours of continuous intravenous infusion from day 2 to day 6. For patients in group B, Melodies multi-channel infusion pump programming to adjust the time of drug administering with a sinusoidal style was adopted; DDP 80 mg/m2 was administered intravenously on day 1 between 10:00 and 22:00 with the peak concentration set at 16:00; fluorouracil 800 mg/m2 was administered between 22:00 and 10:00 on the next day from day 2 to day 6 with the concentration peak set at 4:00. The treatments in both groups were repeated every 21 days, which was repeated for two to six courses of tremtment. Results After three courses of treatment for group A, partial response (PR) rate was 95% (19/20), and after six courses of treatment, the complete remission (CR) rate was 75% (15/20); After two courses of treatment for group B, the PR rate was 100%, and after six courses of treatment, the CR rate was 94.4% (17/18). The main adverse effect was thrombocytopenia at an incidence rate of 35% (7/20) and 22.4% (4/18) in the two groups respectively. There was no obvious difference in other adverse effects between the two groups. Conclusion Chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal carcinoma has obvious advantages in reducing thrombocytopenia caused by chemotherapy, and it is worth further exploring the clinical applications and values of chrono-chemotherapy.
目的:探討鼻咽癌延誤診斷的原因。從而提高鼻咽癌患者的早期診斷率,改善治療效果。方法: 回顧性分析324例在我科接診前因各種因素而延誤診斷的鼻咽癌患者首發癥狀、首診誤診科室、誤診疾病。結果: 本組病例首發癥狀分別為頸部包塊138例(42.5%)、鼻部癥狀148例(45.6%)、耳部癥狀66例(20.3%)、頭痛46例(14.2%)、其他17例(5.2%),有兩種首發癥狀的病例為91例。首診誤診的疾病有頸部淋巴結炎、慢性鼻鼻竇炎、鼻出血、分泌性中耳炎、腦動脈硬化等27種疾病。涉及普外科、耳鼻咽喉科、神經內科、骨科、呼吸內科、口腔科、燒傷科、眼科、中醫科等9個科室。結論: 加強鼻咽癌知識普及,完善繼續醫學教育及住院醫師培訓,積極尋找鼻咽癌的早期診斷方法能減少鼻咽癌的延誤診斷。
【摘要】目的探討頜下腺移位術對預防急性放射性口腔黏膜反應及口干燥癥的臨床效果。方法2007年7月2009年6月間選擇40例患者進行前瞻性臨床對照研究。治療組20例,在放療前將頜下腺移位至頰下區。對照組20例不行頜下腺移位術。觀察放療中兩組急性口腔黏膜反應,測定放療前后唾液分泌量的變化,放療后3個月進行口干燥程度問卷調查。結果治療組急性口腔黏膜反應明顯輕于對照組(Plt;0.05)。治療組放療后3個月移位術側頜下腺攝取、排泌功能均明顯較對照好,兩組比較有統計學意義(Plt;0.05)。結論頜下腺移位術預防鼻咽癌放療后口干燥癥的臨床近期療效較好,可改善鼻咽癌患者放療后的生活質量。
目的:比較常規放射治療與放射治療同期合并順鉑(PDD)加卡培他濱(CAP)治療局部晚期鼻咽癌的有效性,同時評價此聯合方式的安全性。方法:從2003年2月至2005年11月,78例局部晚期鼻咽癌患者(Ⅲ、Ⅳa,92分期)隨機分為兩組,放化療組在放療的第1、4、7周均用PDD+CAP各化療一周期,PDD:20mg/m2,靜脈滴注,連用5天;CAP:1000mg/m2,每天2次,連用14天,休7天;21天為一周期。兩組放療方法相同:鼻咽原發灶采用60Co外照射,頸部淋巴結引流區采用60Co前切線照射加深部X線垂直照射,鼻咽部劑量為65～70 Gy／6.5～7周,頸淋巴結轉移灶劑量為65～70 Gy／6.5～7周。結果:放化療組及單放組治療結束后3個月鼻咽部腫瘤完全消退率分別為89.7%,69.2%(P﹤0.05)。3年生存率分別為76.9%,53.8%(P﹤0.05)。結論:順鉑加卡培他濱方案聯合放化療治療局部晚期鼻咽癌可改善患者的生存,毒副反應可耐受。
目的 檢測血管內皮生長因子（VEGF）、白細胞分化抗原34（CD34）及CXC趨化因子受體4（CXCR4）在轉移性鼻咽癌患者鼻咽部腫瘤組織中的表達，探討它們與鼻咽癌各種臨床病理因素的關系以及它們之間的相互聯系。 方法 采用免疫組織化學鏈霉素抗生物素蛋白-過氧化物酶連結法檢測2003年3月－2009年5月35例轉移性鼻咽癌患者VEGF、CD34及CXCR4在鼻咽部腫瘤組織中的表達情況，結合患者臨床病理特征進行分析。 結果 轉移性鼻咽癌患者鼻咽部腫瘤組織中的VEGF及CXCR4陽性表達率分別為62.9%（22∕35）和42.9%（15∕35），CD34計數為11～92，平均43.2 ± 20.5。無肺轉移較有肺轉移的患者VEGF的陽性表達率高（78.9%、43.8%，P=0.043），多器官轉移較單器官轉移的患者CXCR4的表達強度高（62.5%、26.3%，P=0.044）。 結論 VEGF表達陽性的患者易發生肺轉移；CXCR4強表達的患者易發生多器官轉移。
【摘要】 目的 探討SPECT及CT對鼻咽癌顱底骨侵犯的檢測能力。 方法 2006年5月-2009年12月對159例經病理確診的初治鼻咽癌患者行顱底SPECT斷層顯像，同期行CT檢查，分別計算顱底受侵的陽性率。 結果 ①159例鼻咽癌SPECT顱底斷層陽性率46.5%（74/159），CT陽性率25.2%（40/159），SPECT檢測敏感性高于CT（Plt;0.001）。 ②鼻咽癌伴顱神經損害SPECT檢測敏感性高于CT（P=0.004）。 結論 SPECT對鼻咽癌顱底骨侵犯的檢測敏感性優于CT。【Abstract】 Objective To compare the results of single-photon emission computed tomography (SPECT) and CT in skull base invasion in nasopharyngeal carcinoma (NPC). Methods A total of 159 patients with nasopharyngeal carcinoma were examined by SPECT and CT of nasopharynx and skull base from May 2006 to December 2009. The positive rates were compared by McNemar test. Results The positive rate of skull base invasion detected by SPECT and CT were 46.5% and 25.2% respectively (Plt;0.001). SPECT appeared to be superior to CT in the detection of skull base invasion in NPC with cranial nerve palsy (P=0.004). ConclusionsThe detection ability of SPECT in skull base invasion is superior to that of CT.
摘要:目的:探討鼻咽癌放療后程同步輔以小劑量順鉑增敏的近期療效,并與常規治療和后程加速超分割放射治療進行比較。方法:選取98例Ⅱ～Ⅳ期鼻咽癌患者,隨機分為常規治療組(簡稱T1組,32例)、后程加速超分割治療組(簡稱T2組,32例)和順鉑加后程加速超分割治療組(簡稱T3組,34例),并對治療效果進行比較。 結果:1組鼻咽部腫瘤消除率為75.0%(24／32),頸部淋巴結消除率為87.5%(28/32);T2組鼻咽部腫瘤消除率為87.5%(28／32),頸部淋巴結消除率為84.4%(27/32);T3組鼻咽部腫瘤消除率為97.1%(33／34),頸部淋巴結消除率為91.2%(31/34)。進行兩兩比較,均為P＜0.05,有統計學意義,療效:T3 組＞T2 組＞T1組。治療副作用有增加(P＞0.05),但無統計學意義。 結論:小劑量順鉑加后程加速超分割治療鼻咽癌,可以達到較常規治療更好的近期治療效果。Abstract: Objective: To study the later therapeutic efficacy of nasopharyngeal carcinoma in late course accelerated fractionation (LCAF) radiotherapy and low dose cisplatin, at same time compare with conventional fractionation and LCAF. Methods: Ninetyeight cases with stage ⅡⅣ of nasopharyngeal carcinoma were randomly assigned to three groups: conventional fractionation (T1), LCAF (T2), LCAF and low dose cisplatin (T3). At the end of treatment, therapeutic efficacy was compared with each other. Results: The survey periods was 3 months. Comlete response rate (CR) for groups T1, T2 and T3 was 75.0% (24／32), 87.5% (28／32) and 97.1% (33／34), respectively; the group treated with LCAF and cisplatin had highest effective later therapeutic efficacy than other groups. Lymph node of neck of group T3 got better control, although its side effects were more serious, but no significant difference was found among three group. Conclusion: Combined treatment of LCAF radiotherapy and low dose cisplatin has better later therapeutic efficacy on tumor control in patients with nasopharyngeal carcinoma
ObjectiveTo systematically review the health economic evaluation of nasopharyngeal carcinoma (NPC). MethodsThe PubMed, Web of Science, EMbase, CNKI, WanFang Data and CBM databases were electronically searched to collect the health economic evaluations on NPC from inception to December 18, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A descriptive analysis was performed. ResultsA total of 20 studies were included, which contained 14 about different drug combinations, 6 about chemotherapy and the comparison among intensity modulated radiotherapy, conventional radiotherapy and surgery. The results showed that for patients with recurrent, metastatic, or advanced NPC, compared with docetaxel plus cisplatin, fluorouracil plus cisplatin or docetaxel and cisplatin plus fluorouracil, gemcitabine plus cisplatin (GP) was the most economical, and compared with GP or camrelizumab plus GP, toripalimab plus GP (TGP) was more economical. For early-stage NPC, intensity modulated radiotherapy was not economical compared with conventional radiotherapy and surgery. ConclusionCurrent evidence shows that GP and TGP are economical and can be popularized clinically.