Clinical Research Of Whole Body Hyperthermia Combined With Concurrent Chemoradiotherapy In The Treatment Of Locally Advanced Nasopharyngeal Carcinoma

Objective:Nasopharyngeal carcinoma(NPC)is a malignant tumor occurring in the coated epithelial cells of the nasopharynx.It is characterized by regional aggregation,ethnic aggregation and familial aggregation.It ranks first among the malignant tumors of otorhinolaryngology in China.The etiology is not clear,but the most definite pathogenic factors are:EB virus infection,genetic and environmental factors(diet,non-diet).Due to the characteristics of early lymph node metastasis,high metastasis rate,national economic level and lack of medical knowledge,most of NPC patients are locally advanced at the time of diagnosis.The 5-year overall survival rate was more than 80%,but 20%~30%of the patients still had residual cervical lymph node metastasis and local recurrence or distant metastasis after the standard treatment.It became the main reason for the failure of nasopharyngeal carcinoma treatment,in addition to strengthening the etiological study to prevent or reduce the incidence of nasopharyngeal carcinoma at the root of the disease,how to enhance the clinical efficacy of local advanced nasopharyngeal carcinoma and improve the local control rate,reduce distant metastasis rate is an urgent social need and medical cancer research problem.Hyperthermia is a green antitumor adjuvant therapy which can promote the apoptosis and absorption of tumor cells without harming normal organs and tissues by microwave heating.In recent years,the clinical research of systemic hyperthermia in advanced malignant tumors has made encouraging progress,but the application in the treatment of nasopharyngeal carcinoma is less reported,and the long-term curative effect observation is even less.In this study,systemic hyperthermia combined with radiotherapy and chemotherapy were used to treat locally advanced nasopharyngeal carcinoma to observe the clinical efficacy and safety in the near and long term.Methods:From September 2011 to September 2013,96 patients with locally advanced nasopharyngeal carcinoma who were admitted to the first affiliated Hospital of Zhengzhou University for stageⅢandⅣa of 2008 Chinese nasopharyngeal carcinoma TNM staging of were studied.96 cases of undifferentiated non-keratinized carcinoma were diagnosed by nasopharyngeal biopsy.The patients were randomly divided into control group and observation group,48 cases in each group.Control group:Intensity modulated radiation therapy(IMRT)was used for radiotherapy,and the same IMRT plan was adopted for nasopharynx,upper neck and lower neck.At the same time,chemotherapy began on the first day of radiotherapy and was given three cycles of single cisplatin regimen(cisplatin,100mg/m~2,d1,repeated every 21 days).Observation group:Concurrent chemoradiotherapy was the same as the control group,also given simultaneous hyperthermia at the same time,systemic hyperthermia were given on the day of cisplatin chemotherapy,once every 3 weeks,a total of 3 times.All patients with adverse reactions during treatment were given symptomatic treatment.The data were collected and followed up at the end of the treatment.The short-term effective rate,long-term survival rate,local control rate and adverse reaction rate were observed and compared between the two groups.Results:All patients completed related treatment.The total effective rate(ORR)of primary nasopharyngeal tumor and ORR of cervical lymph node metastasis in the observation group were higher than those in the control group:77.1%VS 52.1%and66.6%VS 45.8%(P<0.05).The 3-year overall(OS),the5-year overall survival rate,5-year local control rate(LCR),and 5-year tumor-free survival rate(DFS)in the observation group and the control group were 81.2%VS 66.6%,68.8%VS 54.2%and 58.3%VS 35.4%,47.9%VS 25.0%were significantly different(P<0.05).The5-year distant metastasis-free survival rate(DMFS)62.5%VS 45.8%,P>0.05)was not significantly different between the two groups.There was no significant difference in the incidence of overall toxicity and side effects between the two groups(P>0.05).Conclusions:Compared with concurrent radiotherapy and chemotherapy alone,the whole body hyperthermia combined with concurrent radiotherapy and chemotherapy could not reduce the long term distant metastasis rate and improve DMFS,but it could significantly improve the clinical short-term effective rate,long-term overall survival rate and local control rate.The whole body hyperthermia does not increase the incidence of toxic side effects,which efficacy is positive,safe,and operational feasibility,worthy of clinical application.