Clinical Study On Patients With Stage Ⅲ,IVa Nasopharyngeal Carcinoma Treated By Radiotherapy And Chemotherapy Combined With Whole Body Hyperthermia

Background:Our province,GuangDong province is the place where the morbidity of nasopharyngeal carcinoma is the highest all over the world, the morbidity reaches up to 34.01 in every ten thousand men and 11.5 in every ten thousand women. For a long time,it always threatens the life health of people of our country especially our province,therefore, besides it is to expected to prevent or reduce morbidity by intensifying etiology research from the root,to find the efficient method to improve the curative effect of nasopharyngeal carcinoma is the urgent social need. Since the reasons that insufficience of social economy level and the level of common people's medical knowledge etc,they cause most patients have been the middle and late period when they are diagnosed,Accordant to the statistics,approximately 60 to 80 percent patients have appeared the transfer of lymphonodi cervicales, and the patients inⅢandⅣstage have taken up 70 percent.So the topic of how to improve the curative effect of nasopharyngeal carcinoma in advanced stage is the important research direction in Clinical medicine.Although there has been great improvement in the control of Primary focal of nasopharyngeal carcinoma because the fast development of radiotherapy technology with modern technology,the five-year survival rate of later period nasopharyngeal carcinoma is only 20 to 30 percent.That is to say mortality is top to 70 to 80 percent.The main cause of death is local recrudescence and the occurrence of distant metastasis.The united chemotherapy can make the degrading of nidus including the metastasis of cervical lymph node speed up and the partial control increase,but the long-term survival rate and distant metastasis rate haven't been improved notably, and the excessive chemotherapy is possible to cause the danger lead by therapy. It has been approved by a lot of experimental research and clinical research that Thermal therapy can improve the killing effects of tumour by radiotherapy and chemotherapy,after 2000 years,the clinical research of whole body hyperthermia is gradually launched in scale and single disease and fixed united therapeutic schedule,the preliminary result is encouraging.In Europe and America,there are the clinical research ofⅡandⅢperiod which are in the works. Moreover whether the whole body hyperthermia united concurrent chemoradiotherapy can benefit the middle and later-period nasopharyngeal carcinoma is the problem which the medical field in China pay close attention to in general.Research purpose:To cure patients with stageⅢ,Ⅳa nasopharyngeal carcinoma using whole body hyperthermia and uniting the current standard therapeutic schedule of nasopharyngeal carcinoma,analyze whether they can better partial control and prevent or put off the occurrence of distant metastasis.Material and method:60 preliminarily-cured nasopharyngeal carcinoma patients have been diagnosed to be undifferentiated type (non) Angle of carcinoma by nasal pharyngoscopy pathology,and are inⅢandⅣa period according to 2008 Guangzhou stages.There are 21 examples in radiotherapy and pharmaceutical chemistry treatment combined with whole body hyperthermia group(HT+RT+CT) ,and 39 examples in radiotherapy and pharmaceutical chemistry treatment group(RT+CT).Both groups accept 6MV X ray external beam radiation therapy and whole body chemotherapy, the total dose in pars nasalis pharyngis is 70-76Gy, neck treat dose is 60-64Gy, prevention dose is 50-55Gy;The whole-body chemotherapy is connected with synchronize chemotherapy and adjuvant chemotherapy . The synchronize chemotherapy begins on the first week, cis-platinum 80mg/㎡ with 500ml physiology saline intravenous drip,the first day,once every three weeks;adjuvant chemotherapy begins after three weeks when radiotherapy is finished,adopting PF scheme, cis-platinum 80mg/㎡, with 500ml physiology saline intravenous drip,the first day;5-Fu 500mg/㎡,add 500ml 5% glucose solution intravenous drip,the first one to five days, repeated every three weeks.While in HT+RT+CT group,whole body hyperthermia is carried out on the right day when cis-platinum chemotherapy is executed .Before heated rectum temperature measuring line measure the temperature, the remedy temperature is 39.8℃~ 40.5℃.When it reaches the remedy temperature,infuse cis-platinum, and keep two hours in constant temperature.Result:There are 60 examples of preliminarily-cured nasopharyngeal carcinoma patients who have been treated by radiotherapy and chemotherapy combined with whole body hyperthermia,or radiotherapy and chemotherapy ,and after three months they have finished,conduct the recent curative effect evaluation. Complete response rate of thermal radiotherapy and chemotherapy is 90.5%(19/21),conventional radiotherapy and chemotherapy group is 66.7%(26/39).The difference of two groups has statistic meaning (p<0.05); thermal radiotherapy and chemotherapy group of degrading dose of pars nasalis pharyngis tumor is 52.38Gy , conventional radiotherapy and chemotherapy group is 64.10Gy,there is significance of the difference comparing the two groups. (p<0.05) ;The thermal radiotherapy and chemotherapy group of degrading dose of cervical lymph node is 46.19Gy,conventional radiotherapy and chemotherapy group is 54.35Gy,there is significance of the difference comparing the two groups (p<0.05).the treat of related adverse reaction of two groups is resemble. Conclusion:1. The local control rates of nasopharyngeal carcinoma of advanced stage can be obviously improved treated by radiotherapy and chemotherapy combined with whole body hyperthermia,which deserves for further clinical research and application.2. Whether can thermal united radiotherapy and chemotherapy decrease recurring probability and the occurance of distant metastasis and improve survival rate, and whether there is an increase of the related adverse reaction in earlier therapy, these are all what we should observe and investigate in hereafter follow-up visit.