目的 通過對現有醫學證據的檢索和評價,指導局部晚期鼻咽癌的治療.方法 首先提出相關臨床問題,然后對Medline(1985-2002),Embase(1985-2002),Cochrane圖書館(2002,1期)和ACP網站進行檢索,并對檢索結果進行評價.檢索詞包括:"Nasopharyngeal carcinoma and chemotherapy and radiotherapy and randomized"及"Meta analysis orrandomized control trial".結果 通過檢索,一共查到了一篇系統評價,16篇樣本量較大的隨機臨床研究.其中8篇為三期臨床研究.大多研究表明放化療聯合治療優于單獨放療.這些結果也適用于我們的病人.結論 通過檢索和評價,我們對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,但對化療方案進行了相應調整.
【摘要】 目的 利用不同匹配區域對錐形束CT（CBCT）與定位CT（FBCT）分別配準，測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，調整治療床前198次CBCT掃描。將鼻咽部掃描CBCT圖像匹配區域分為上下兩個區域進行對比分析。其中上匹配區域為:上界為蝶竇上緣，下界為頸4下緣，側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；下匹配區域為:上界約頸4下緣，下界約胸2-3下緣，側界包括椎體外輪廓，前界包括皮膚，后界平棘突后緣。匹配方式選擇骨，比較匹配結果差異。 結果 選擇上與下匹配區域結果除Y（頭腳）方向旋轉誤差無統計學差異外，余均有統計學差異（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，旋轉誤差X、Y、Z方向分別為（0.90±1.98）、（0.80±2.03）、（0.68±1.90）°。 結論 鼻咽癌放射治療中頸部區域存在一定變形誤差，通過CBCT引導發現變形誤差并進行正確糾正是必須的，結合臨床實際及靶區與危及器官的變化為重新計劃提供依據。【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 評價中藥復方（益氣養陰、清熱活血方Yiqi Yangyin Qingre Huoxue decoction，YYQHD）聯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系統評價方法，電子檢索Cochrane圖書館臨床對照試驗資料庫（Cochrane Central Register of Controlled Trials，CENTRAL）、PubMed、EMBASE、中國生物醫學文獻數據庫（CBM）、中文科技期刊全文數據庫（CNKI）和中國期刊全文數據庫（VIP）以及萬方數據庫等數據庫2010年3月前所發表的相關文獻。同時互聯網檢索Current Controlled Trial、Clinical Trials和中國臨床試驗注冊網。手工檢索部分腫瘤類核心期刊。采用Cochrane協作網推薦的 “偏倚風險評估”工具，評估納入研究的質量，使用RevMan 5.0.23.0軟件對納入的研究進行定量系統評價。 結果 最終納入符合標準的中文文獻9篇共795例患者。定量分析結果顯示:與單純常規放射治療相比較，中藥復方（YYQHD）聯合常規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的發生，從而提高放射治療按時完成率確保放射治療療效、改善患者生存質量。 結論 雖現有研究尚不能得出可以將中藥復方（YYQHD）作為標準治療手段輔助放射治療的結論，但提示益氣養陰、清熱活血類中藥聯合放射治療治療鼻咽癌是值得繼續探索的研究方向，期待設計科學合理、高質量的多中心、大樣本、雙盲、隨機對照臨床試驗以進一步驗證其療效。【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.
【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.
