同期放化疗治疗中晚期鼻咽癌临床研究

Radiotherapy with concurrent chemotherapy for treatment of advanced nasopharyngeal carcinoma

目的观察及评价同期放化疗治疗中晚期鼻咽癌(Ⅲ或Ⅳa期)的疗效.方法 80例确诊为Ⅲ、Ⅳa期的中晚期鼻咽癌患者随机分为同期放化疗组(A组)和单纯放疗组(B组),每组40例.A组给予甲酰四氢叶酸+5-氟脲嘧啶+顺铂联合化疗,4周后给予第二程化疗;B组只给单纯放射治疗.两组放疗方法相同,为常规分割剂量,鼻咽放疗剂量为66～76Gy/6.6～7.6周,颈淋巴结放疗剂量为60～72 Gy/6.0～7.2周.结果所有病人均顺利完成既定治疗方案.A组同B组治疗结束时鼻咽原发灶和颈淋巴结消退率分别是77.5%vs 60.0%(P＞0.05)和92.5%vs 70.0%(P＜0.05);治疗后3个月,两组鼻咽原发灶和颈淋巴结消退率分别为92.5%vs 72.5%(P<0.05)和100%vs 85.0%(P＜0.05).毒副作用:A组胃肠道反应、骨髓毒性高于B组(P＜0.01);两组口腔粘膜及皮肤反应程度相当.结论同期放化疗可以提高中晚期(Ⅲ或Ⅳa期)鼻咽癌患者的肿瘤消退率,其毒性反应可以耐受,不影响放疗的顺利完成.放疗前诱导化疗能缩短治疗时间,是鼻咽癌综合治疗的可行性方法.

Objective To evaluate the effect of radiotherapy combined with concurrent chemotherapy for the treatment of advanced nasopharyngeal carcinoma. Methods From February 2001 to August 2003, 80 cases of nasopharyngeal carcinoma (stage Ⅲand Ⅳa) were randomized into two groups to receive radiotherapy with concurrent chemotherapy (Group A, n=40) consisted of leucovorin (CF, 100 mg/m 2 , days 1-5), 5-fluorouracil (5-Fu, 500 mg/m 2 , days 1-5), cisplatin (DDP, 60 mg/m 2 , day 1) for one course followed by another 4 weeks later, or radiotherapy alone (Group B, n=40). In all cases, the radiotherapy followed the same protocol, with the nasopharyngeal (NP) total dose (DT) of 66-76 Gy given in 6.6-7.6 weeks, and cervical lymphnode (LN) DT of 60-72 Gy completed in 6.0-7.2 weeks. Results All patients completed the treatment course, and the complete response rates of the primary lesions and cervical nodes in A and B groups were 77.5% and 60.0% (P>0.05) and 92.5% vs70.0% (P<0.05), respectively, which were 92.5% vs72.5% (P<0.05) and 100% vs85.0% (P<0.05), respectively, 3 months after treatment. No obvious toxicity was observed in the two groups except for vomiting and leukopenia. Conclusion Radiotherapy with concurrent chemotherapy can improve the elimination rate of advanced nasopharyngeal carcinoma, and can be completed in shorter treatment course in comparison with neoadjuvant chemotherapy before radiotherapy, eligible for clinical practice in the treatment of advanced nasopharyngeal carcinoma.