目的 通過對(duì)現(xiàn)有醫(yī)學(xué)證據(jù)的檢索和評(píng)價(jià),指導(dǎo)局部晚期鼻咽癌的治療.方法 首先提出相關(guān)臨床問題,然后對(duì)Medline(1985-2002),Embase(1985-2002),Cochrane圖書館(2002,1期)和ACP網(wǎng)站進(jìn)行檢索,并對(duì)檢索結(jié)果進(jìn)行評(píng)價(jià).檢索詞包括:"Nasopharyngeal carcinoma and chemotherapy and radiotherapy and randomized"及"Meta analysis orrandomized control trial".結(jié)果 通過檢索,一共查到了一篇系統(tǒng)評(píng)價(jià),16篇樣本量較大的隨機(jī)臨床研究.其中8篇為三期臨床研究.大多研究表明放化療聯(lián)合治療優(yōu)于單獨(dú)放療.這些結(jié)果也適用于我們的病人.結(jié)論 通過檢索和評(píng)價(jià),我們對(duì)該患者選擇了新輔助化療+同步放化療+輔助化療的治療方案,但對(duì)化療方案進(jìn)行了相應(yīng)調(diào)整.
【摘要】 目的 利用不同匹配區(qū)域?qū)﹀F形束CT（CBCT）與定位CT（FBCT）分別配準(zhǔn)，測(cè)量出鼻咽癌放射治療中頸部的變形誤差。 方法 分析2007年4月-2008年12月收治鼻咽癌患者23例，調(diào)整治療床前198次CBCT掃描。將鼻咽部掃描CBCT圖像匹配區(qū)域分為上下兩個(gè)區(qū)域進(jìn)行對(duì)比分析。其中上匹配區(qū)域?yàn)?上界為蝶竇上緣，下界為頸4下緣，側(cè)界包括下頜骨外輪廓，前界為上頜竇1/2，后界為平棘突后緣；下匹配區(qū)域?yàn)?上界約頸4下緣，下界約胸2-3下緣，側(cè)界包括椎體外輪廓，前界包括皮膚，后界平棘突后緣。匹配方式選擇骨，比較匹配結(jié)果差異?！〗Y(jié)果 選擇上與下匹配區(qū)域結(jié)果除Y（頭腳）方向旋轉(zhuǎn)誤差無(wú)統(tǒng)計(jì)學(xué)差異外，余均有統(tǒng)計(jì)學(xué)差異（Plt;0.05） 。差值在X（左右）、Z（前后）、Y（頭腳）方向平移分別為（1.14±2.80）、（0.47±1.41）、（0.58±3.88） mm，旋轉(zhuǎn)誤差X、Y、Z方向分別為（0.90±1.98）、（0.80±2.03）、（0.68±1.90）°?！〗Y(jié)論 鼻咽癌放射治療中頸部區(qū)域存在一定變形誤差，通過CBCT引導(dǎo)發(fā)現(xiàn)變形誤差并進(jìn)行正確糾正是必須的，結(jié)合臨床實(shí)際及靶區(qū)與危及器官的變化為重新計(jì)劃提供依據(jù)。【Abstract】 Objective To investigate the rotation errors due to neck deformation in nasopharyngeal cancer (NPC) radiotherapy with different match areas to register conebeam CT(CBCT) from image guiding and fanbeam (FBCT) from simulation. Methods A total of 198 pre-correction CBCT data sets from 23 NPC patients from April 2007 to December 2008 were retrospectively analyzed. The matching areas in CBCT images were divided into up and down region of interest (ROI). For the up ROI, the superior, inferior, left and right, anterior, and posterior boundary were set parallel with sphenoid sinus up side, C4 down side, mandible outside, and 1/2 of maxillary air sinus and acanthi. For the down ROI, the lines were set parallel with C4 down side, T2-3 down side, neck outside, skin surface and acanthi respectively in all directions. All registrations were performed automatically by bony anatomy and the results were compared. Results The registration results by the up and the down ROI showed significant difference except Y direction for rotation. The translation error was (1.14±2.80),(0.47±1.41),and (0.58±3.88) mm, respectively; and the rotation error was (0.90±1.98),(0.80±2.03),and (0.68±1.90) ° in X, Y, and Z direction, respectively. 〖WTHZ〗Conclusions〖WTBZ〗There are some significant deformation errors at neck areas in NPC radiotherapy. It is important to find out the deformation and correct it with CBCT image guiding. This kind of error information may provide clues for re-planning in addition to clinical practice and the changes of clinical targets and involved organs.
摘要:目的：探討同期放化療治療中晚期鼻咽癌的療效。方法: 我院2003年6月至2006年10月中晚期鼻咽癌患者95例回顧分析, 兩組放射治療相同, 用6 MV-X線外照射和6～12 MeV電子線, 觀察組放療始PF方案同步化療。結(jié)果：兩組治療結(jié)束后3個(gè)月觀察組鼻咽癌原發(fā)病灶療效有效率高于對(duì)照組(Plt;0.05), 頸部淋巴結(jié)療效有效率高于對(duì)照組(Plt;0.05), 兩組患者不良反應(yīng)主要為急性黏膜反應(yīng)、骨髓抑制、胃腸道反應(yīng)等。觀察組的毒副作用發(fā)生率明顯高于對(duì)照組(Plt;0.05)。結(jié)論：同期放化療治療中晚期(Ⅲ或Ⅳa期)鼻咽癌是目前較為理想的治療方案, 其毒性反應(yīng)可以耐受。
目的 檢測(cè)血管內(nèi)皮生長(zhǎng)因子（VEGF）、白細(xì)胞分化抗原34（CD34）及CXC趨化因子受體4（CXCR4）在轉(zhuǎn)移性鼻咽癌患者鼻咽部腫瘤組織中的表達(dá)，探討它們與鼻咽癌各種臨床病理因素的關(guān)系以及它們之間的相互聯(lián)系。 方法 采用免疫組織化學(xué)鏈霉素抗生物素蛋白-過氧化物酶連結(jié)法檢測(cè)2003年3月－2009年5月35例轉(zhuǎn)移性鼻咽癌患者VEGF、CD34及CXCR4在鼻咽部腫瘤組織中的表達(dá)情況，結(jié)合患者臨床病理特征進(jìn)行分析。 結(jié)果 轉(zhuǎn)移性鼻咽癌患者鼻咽部腫瘤組織中的VEGF及CXCR4陽(yáng)性表達(dá)率分別為62.9%（22∕35）和42.9%（15∕35），CD34計(jì)數(shù)為11～92，平均43.2 ± 20.5。無(wú)肺轉(zhuǎn)移較有肺轉(zhuǎn)移的患者VEGF的陽(yáng)性表達(dá)率高（78.9%、43.8%，P=0.043），多器官轉(zhuǎn)移較單器官轉(zhuǎn)移的患者CXCR4的表達(dá)強(qiáng)度高（62.5%、26.3%，P=0.044）。 結(jié)論 VEGF表達(dá)陽(yáng)性的患者易發(fā)生肺轉(zhuǎn)移；CXCR4強(qiáng)表達(dá)的患者易發(fā)生多器官轉(zhuǎn)移。
【摘要】 目的 評(píng)價(jià)中藥復(fù)方（益氣養(yǎng)陰、清熱活血方Y(jié)iqi Yangyin Qingre Huoxue decoction，YYQHD）聯(lián)合放射療法治療鼻咽癌在減毒增效方面的療效。 方法 采用Cochrane系統(tǒng)評(píng)價(jià)方法，電子檢索Cochrane圖書館臨床對(duì)照試驗(yàn)資料庫(kù)（Cochrane Central Register of Controlled Trials，CENTRAL）、PubMed、EMBASE、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)（CBM）、中文科技期刊全文數(shù)據(jù)庫(kù)（CNKI）和中國(guó)期刊全文數(shù)據(jù)庫(kù)（VIP）以及萬(wàn)方數(shù)據(jù)庫(kù)等數(shù)據(jù)庫(kù)2010年3月前所發(fā)表的相關(guān)文獻(xiàn)。同時(shí)互聯(lián)網(wǎng)檢索Current Controlled Trial、Clinical Trials和中國(guó)臨床試驗(yàn)注冊(cè)網(wǎng)。手工檢索部分腫瘤類核心期刊。采用Cochrane協(xié)作網(wǎng)推薦的 “偏倚風(fēng)險(xiǎn)評(píng)估”工具，評(píng)估納入研究的質(zhì)量，使用RevMan 5.0.23.0軟件對(duì)納入的研究進(jìn)行定量系統(tǒng)評(píng)價(jià)?！〗Y(jié)果 最終納入符合標(biāo)準(zhǔn)的中文文獻(xiàn)9篇共795例患者。定量分析結(jié)果顯示:與單純常規(guī)放射治療相比較，中藥復(fù)方（YYQHD）聯(lián)合常規(guī)放射治療能顯著提高腫瘤近期療效、生存率，并且能顯著減少放射治療常見毒副反應(yīng)的發(fā)生，從而提高放射治療按時(shí)完成率確保放射治療療效、改善患者生存質(zhì)量。 結(jié)論 雖現(xiàn)有研究尚不能得出可以將中藥復(fù)方（YYQHD）作為標(biāo)準(zhǔn)治療手段輔助放射治療的結(jié)論，但提示益氣養(yǎng)陰、清熱活血類中藥聯(lián)合放射治療治療鼻咽癌是值得繼續(xù)探索的研究方向，期待設(shè)計(jì)科學(xué)合理、高質(zhì)量的多中心、大樣本、雙盲、隨機(jī)對(duì)照臨床試驗(yàn)以進(jìn)一步驗(yàn)證其療效。【Abstract】 Objective To compare the efficacy of traditional Chinese medicine (TCM) plus radiotherapy (RT) with RT alone on nasopharyngeal carcinoma (NPC) by Yiqi Yangyin Qingre Huoxue decoction (YYQHD) through a meta-analysis of all available randomized controlled trials. Methods Literature retrieval was conducted using the Cochrane Library, PubMed, EMBASE, CBMdisk, CNKI, VIP, and Wanfang Database electronically. Relevant journals and conference proceedings were also hand-searched until March 31, 2010. The quality of included studies was assessed according to the criteria recommended by the Cochrane handbook, and the Meta-analysis was performed for homogeneous studies using RevMan 5.0.23.0 Software. Results Basing on our search criteria, we found nine trials (795 patients) which all published in Chinese. Our results showed that TCM (YYQHD) plus RT compared with RT alone, improved immediate tumor response, survival, completion rate of RT, quality of life, and alleviation of adverse effect of patients with NPC. Conclusions Considering the limitations related to this Meta-analysis, it nevertheless presents credible evidence that TCM (YYQHD) plus RT is worthy of additional study. Therefore, further large-scale, muti-center, randomized, and double-blind trials are warranted.
【摘要】 目的 觀察時(shí)辰化學(xué)療法聯(lián)合放射治療對(duì)比常規(guī)化學(xué)療法聯(lián)合放射治療對(duì)鼻咽癌的近期療效及其不良反應(yīng)?！》椒ā?006年2月-2010年3月經(jīng)病理學(xué)證實(shí)未接受過化學(xué)療法的38例晚期鼻咽癌患者隨機(jī)分為常規(guī)化學(xué)療法聯(lián)合放射治療組（A組，n=20）和時(shí)辰化學(xué)療法聯(lián)合放射治療組（B組，n=18）。兩組均采用常規(guī)二維放射治療。A組化學(xué)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(xù)靜脈滴注。B組時(shí)辰化學(xué)療法采用Melodies多通道編程輸液泵進(jìn)行正弦曲線式時(shí)間調(diào)節(jié)給藥。兩組均為DDP 80 mg/m2，于10:00~22:00給藥，濃度高峰設(shè)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(shè)定在凌晨4:00。每21天重復(fù)1次，行2~6療程?！〗Y(jié)果 A組3程化學(xué)療法后有效率（PR）為95%（19/20），全程結(jié)束完全緩解率（complete remission，CR）達(dá)75%（15/20）；B組在2程化學(xué)療法后PR達(dá)100%，全程治療結(jié)束CR達(dá)94.4%（17/18）。兩組不良反應(yīng)主要為遲發(fā)性血小板減少，發(fā)生率分別為35%（7/20）和22.2%（4/18），其他不良反應(yīng)兩組間無(wú)明顯差別?！〗Y(jié)論 時(shí)辰化學(xué)療法聯(lián)合放射治療對(duì)晚期鼻咽癌在減輕化學(xué)療法造成的血小板減少方面有明顯的優(yōu)勢(shì)，值得臨床推廣應(yīng)用以及進(jìn)一步發(fā)掘時(shí)辰化學(xué)療法在臨床治療的價(jià)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.
【摘要】目的探討頜下腺移位術(shù)對(duì)預(yù)防急性放射性口腔黏膜反應(yīng)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(jìn)行前瞻性臨床對(duì)照研究。治療組20例,在放療前將頜下腺移位至頰下區(qū)。對(duì)照組20例不行頜下腺移位術(shù)。觀察放療中兩組急性口腔黏膜反應(yīng),測(cè)定放療前后唾液分泌量的變化,放療后3個(gè)月進(jìn)行口干燥程度問卷調(diào)查。結(jié)果治療組急性口腔黏膜反應(yīng)明顯輕于對(duì)照組(Plt;0.05)。治療組放療后3個(gè)月移位術(shù)側(cè)頜下腺攝取、排泌功能均明顯較對(duì)照好,兩組比較有統(tǒng)計(jì)學(xué)意義(Plt;0.05)。結(jié)論頜下腺移位術(shù)預(yù)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(zhì)量。
【摘要】目的探討鼓膜置管對(duì)鼻咽癌(NPC)患者放療前后分泌性中耳炎(SOM)的療效。方法2005年3月2010年1月將60例(84耳)NPC并發(fā)SOM患者分為兩組:A組30例行鼓膜切開鼓膜置管;B組30例保守治療為對(duì)照組,并行隨訪,對(duì)兩組患者有效率和并發(fā)癥發(fā)生率進(jìn)行統(tǒng)計(jì)。結(jié)果60例中58例存活,1例死于全身衰竭,1例死于大出血。存活患者中治療SOM有效率為:A組85.4%(35/41),B組為30.2%(13/43),兩組差異有統(tǒng)計(jì)學(xué)意義(Plt;0.05);并發(fā)癥發(fā)生率A組為14.6%(6/41),B組為69.8%(30/43),B組并發(fā)癥高于A組,差異有統(tǒng)計(jì)學(xué)意義(Plt;0.05)。結(jié)論NPC患者在放療后,咽鼓管功能受到嚴(yán)重?fù)p害,是不可逆的病變,鼓膜置管治療NPC并發(fā)SOM較保守治療效果好,并發(fā)癥的發(fā)生率低。
【摘要】 目的 探討外照射加腔內(nèi)放射治療（放療）對(duì)于局部復(fù)發(fā)鼻咽癌的臨床療效及價(jià)值。 方法 采用60Co γ射線對(duì)1998年8月-2003年8月收治的34例放療后局部復(fù)發(fā)的鼻咽癌患者進(jìn)行常規(guī)外照射。劑量為58～62 Gy，其中20例補(bǔ)充了腔內(nèi)放射治療，劑量參考點(diǎn)為黏膜下5 mm，每次劑量5 Gy，2～3次，間隔3～4 d。 結(jié)果 5年生存率為41.1%（14/34），局控率為47.0%（16/34），遠(yuǎn)處轉(zhuǎn)移率為23.5%（8/34），補(bǔ)充腔內(nèi)放療的20例，5年生存率65%（13/20），未補(bǔ)充腔內(nèi)放射治療的14例，5年生存率為28.5%（4/14），比較有統(tǒng)計(jì)學(xué)意義（Plt;0.05）。 結(jié)論 鼻咽癌根治放療后局部復(fù)發(fā)再行放療仍是主要且為有效的治療方法。外照射加腔內(nèi)放療對(duì)于復(fù)發(fā)患者其在降低外照射劑量的同時(shí)，不降低局控率及生存率；在恰當(dāng)?shù)募夹g(shù)條件下尚未觀察到嚴(yán)重并發(fā)癥。加用腔內(nèi)放療的患者5年生存率高于單純外照組。
【摘要】 目的 探討SPECT及CT對(duì)鼻咽癌顱底骨侵犯的檢測(cè)能力。 方法 2006年5月-2009年12月對(duì)159例經(jīng)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(jì)算顱底受侵的陽(yáng)性率。 結(jié)果 ①159例鼻咽癌SPECT顱底斷層陽(yáng)性率46.5%（74/159），CT陽(yáng)性率25.2%（40/159），SPECT檢測(cè)敏感性高于CT（Plt;0.001）。 ②鼻咽癌伴顱神經(jīng)損害SPECT檢測(cè)敏感性高于CT（P=0.004）。 結(jié)論 SPECT對(duì)鼻咽癌顱底骨侵犯的檢測(cè)敏感性優(yōu)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.