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目的观察调强放疗联合紫杉醇治疗老年局部晚期下咽癌的近期疗效和毒副反应。方法 64例老年局部晚期下咽癌患者,按治疗方法不同分为调强放疗加紫杉醇组(调强+化组)和适形放疗组(适形组),各32例。调强+化组采用6MV-X射线调强放疗,照射剂量66~70 Gy,1.8~2.0 Gy/次,1次/d,5 d/周。每周给予紫杉醇60 mg静脉滴注(从放疗第2天开始);适形组采用6MV-X射线照射,照射剂量68~70 Gy,1.8~2.0 Gy/次,1次/d,5 d/周。观察两组临床疗效。结果调强+化组CR 27例(84.4%),适形组CR 20例(62.5%),两组比较差异有统计学意义(P<0.05);调强+化组与适形组毒副反应中胃肠道反应、口腔黏膜反应比较差异无统计学意义(P>0.05);调强+化组骨髓抑制明显高于适形组(P<0.05);调强+化组1年生存率明显高于适形组(P<0.01);调强+化组3年生存率明显高于适形组(P<0.05)。结论调强放疗联合紫杉醇治疗老年局部晚期下咽癌有很好的近期疗效,毒副反应较轻,能被老年患者耐受,可在临床进一步推广。
Objective To observe the short-term curative effect and toxicity of combined intensity radiotherapy and paclitaxel in the treatment of elderly locally advanced hypopharyngeal carcinoma. Methods Sixty-four elderly patients with locally advanced hypopharyngeal carcinoma undergoing radiofrequency ablation plus paclitaxel (IMG) and conformal radiotherapy (conformal radiotherapy), 32 patients in each group, were divided into two groups. IMRT + 6MV-X-ray intensity-modulated radiotherapy was used at doses of 66-70 Gy, 1.8-2.0 Gy, 1 / d and 5 d / week. Paclitaxel was administered intravenously 60 mg weekly (beginning on day 2 of radiotherapy); conformal groups were treated with 6MV-X irradiation at a dose of 68-70 Gy, 1.8-2.0 Gy / time, once / d, 5 d / week. The clinical effects of two groups were observed. Results Twenty-seven patients (84.4%) were CR + T group and 20 (62.5%) patients were CR group (P <0.05). There was no significant difference between the two groups There was no significant difference in gastrointestinal reaction and oral mucosal response between the two groups (P> 0.05). The bone marrow suppression in group A and group B was significantly higher than that in conformal group (P <0.05) (P <0.01). The 3-year survival rate of IMRI group was significantly higher than that of conformal group (P <0.05). Conclusion IMRT combined with paclitaxel has good short-term curative effect in the treatment of elderly locally advanced hypopharyngeal carcinoma with mild toxicity and can be tolerated by elderly patients and can be further promoted in clinic.