Analysis of the short-term efficacy and side effects of concurrent chemoradiotherapy combined with nimotuzumab in patients with locally advanced nasopharyngeal carcinoma
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摘要:
目的 鼻咽癌具有独特的解剖学和生物学特性，放疗或同步放化疗是一种有效的治疗模式，然而，仍有许多局部晚期鼻咽癌患者出现局部复发或远处转移，因此，靶向治疗为鼻咽癌患者提供了更多的选择。本研究旨在评估同步放化疗联合尼妥珠单抗在治疗局部晚期鼻咽癌患者中的近期疗效和毒副反应，并进一步分析调强放射治疗(IMRT)和螺旋断层放射治疗(TOMO)对患者副反应的影响。 方法 回顾性分析2020年12月—2023年6月蚌埠医科大学第一附属医院放疗科收治的88例局部晚期鼻咽癌患者的临床资料，治疗组44例患者接受同步放化疗联合尼妥珠单抗靶向治疗，对照组44例患者仅接受同步放化疗，对比分析2组的近期疗效和毒副反应发生情况以及不同放疗方法对副反应的影响。 结果 治疗组患者鼻咽部和颈部淋巴结的总有效率(ORR)分别为97.8%(43/44)和93.2%(41/44)，对照组的ORR分别为81.8%(36/44)和81.8%(36/44)。治疗组的黏膜炎发生率高于对照组[84.1%(37/44)vs. 63.6%(28/44), P<0.05]。进一步分析显示治疗组和对照组中接受TOMO放疗的患者黏膜炎发生率均低于IMRT，但差异无统计学意义(P＞0.05)。 结论 对于局部晚期的鼻咽癌患者，同步放疗化疗联合尼妥珠单抗近期疗效更好，采用TOMO放疗的患者黏膜反应有降低趋势。 Abstract:Objective Nasopharyngeal carcinoma has unique anatomical and biological characteristics, and radiotherapy or concurrent chemoradiotherapy is an effective treatment mode. However, many patients with locally advanced nasopharyngeal carcinoma still experience local recurrence or distant metastasis. Therefore, targeted therapy provides an additional option for nasopharyngeal carcinoma patients. This article aims to evaluate the short-term efficacy and toxicity of concurrent chemoradiotherapy combined with nimotuzumab in the treatment of locally advanced nasopharyngeal carcinoma patients, and further analyze the impact of intensity-modulated radiation therapy (IMRT) and helical tomotherapy (TOMO) on patiens' side effects. Methods A retrospective analysis was conducted on the clinical data of 88 patients with locally advanced nasopharyngeal carcinoma admitted to the Radiotherapy Department of the First Affiliated Hospital of Bengbu Medical University from December 2020 to June 2023. The treatment group consisted of 44 patients who received concurrent chemoradiotherapy with nimotuzumab targeted therapy, while the control group consisted of 44 patients who only received concurrent chemoradiotherapy. The short-term treatment efficacy, toxic side effects, and the impact of different radiotherapy methods on side effects were compared and analyzed. Results In the treatment group, the overall response rate (ORR) for the nasopharyngeal region and cervical lymph nodes were 97.8% (43/44) and 93.2% (41/44) respectively, while in the control group, the ORR were 81.8%(36/44) and 81.8% (36/44) respectively. The incidence of mucositis was higher in the treatment group compared to the control group: 84.1%(37/44) compared to 63.6%(28/44), P<0.05. Further analysis showed that the incidence of mucositis was lower in patients receiving TOMO in both the treatment and control groups than in the IMRT, but the difference was not statistically significant (P>0.05). Conclusion For patients with locally advanced nasopharyngeal carcinoma, concurrent chemoradiotherapy with nimotuzumab provides better short-term efficacy, while patients receiving TOMO have a decreasing trend in mucosal reactions. -
Key words:
- Nasopharyngeal carcinoma /
- Nimotuzumab /
- Radiotherapy /
- Efficacy /
- Side effects
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表 1 2组局部晚期鼻咽癌患者一般临床资料比较(例)
Table 1. Comparison of general clinical data between the two groups of patients with locally advanced nasopharyngeal carcinoma (cases)
组别 例数 性别 年龄(岁) KPS(分) T N 放疗技术 男性 女性 ≥60 ＜60 ≥90 ＜90 1~2 3~4 0~1 2~3 IMRT TOMO 治疗组 44 36 8 10 34 31 13 13 31 21 23 29 15 对照组 44 30 14 8 36 27 17 17 27 19 25 14 30 χ2值 2.182 2.279 0.809 0.809 0.183 10.233 P值 0.140 0.597 0.368 0.368 0.669 0.001 
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表 2 2组局部晚期鼻咽癌患者近期疗效比较[例(%)]
Table 2. Comparison of short-term efficacy between the two groups of patients with locally advanced nasopharyngeal carcinoma [cases (%)]
组别 例数 完全缓解 部分缓解 稳定 进展 ORR 鼻咽部治疗组 44 20(45.5) 23(52.3) 1(2.2) 0 43(97.8) 鼻咽部对照组 44 12 (27.3) 24(54.5) 8(18.2) 0 36(81.8) χ2值 4.456 P值 0.035 组别 例数 完全缓解 部分缓解 稳定 进展 ORR 颈部治疗组 44 13 (29.5) 28(63.7) 3(6.8) 0 41(93.2) 颈部对照组 44 17 (38.6) 19(43.2) 8(18.2) 0 36(81.8) χ2值 2.597 P值 0.107
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表 3 2组局部晚期鼻咽癌患者急性副反应发生情况比较(例)
Table 3. Comparison of acute side effects between the two groups of patients with locally advanced nasopharyngeal carcinoma (cases)
组别 反应级别 血液类 非血液类 白细胞减少 中性粒减少 贫血 血小板减少 急性胃肠道反应 疲乏 肝肾功能受损 口腔黏膜炎症 放射性皮炎 治疗组 0级 12 19 23 28 8 40 39 7 19 1~2级 22 17 20 14 32 4 5 17 18 3~4级 10 8 1 2 4 0 0 20 7 对照组 0级 19 29 26 23 9 40 37 16 21 1~2级 17 11 18 17 30 4 7 14 19 3~4级 8 4 0 4 5 0 0 14 4 χ2值 2.440 4.583 0.414 1.166 0.073 0.000 0.386 4.768 0.183 P值 0.118 0.320 0.520 0.280 0.787 1.000 0.534 0.029 0.669
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表 4 2组局部晚期鼻咽癌患者口腔黏膜炎发生情况比较(例)
Table 4. Comparison of the incidence of oral mucositis between the two groups of patients with locally advanced nasopharyngeal carcinoma (cases)
组别 治疗组 对照组 阳性 阴性 阳性 阴性 IMRT 27 2 10 4 TOMO 10 5 18 12 χ2值 3.378 0.539 P值 0.066 0.463
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