不同途径化疗联合放疗对局部晚期鼻咽癌的近期疗效

Short-term Effects of Chemotherapy through Different Approaches Combined with Radiotherapy for Local Advanced Nasopharyngeal Carcinoma

目的比较不同途径化疗联合放疗对局部晚期鼻咽癌的近期疗效。方法68例局部晚期鼻咽癌患者入组,介入组30例采用Seldinger法选择性咽升动脉或上颌动脉插管灌注顺铂(DDP)+5氟脲嘧啶(5Fu),在第2次介入化疗后1周常规放疗,对照组38例应用相同药物进行全身化疗,在第2次全身化疗后1周常规放疗。2组放疗方法、时间、剂量分割相同。结果介入组总有效率为100.0%,其中CR80.0%(24/30),对照组总有效率为100.0%,其中CR78.9%(30/38),2组比较无显著性差异(P>0.05);治疗结束3～6个月后CT检查证实鼻咽部肿瘤完全消退率介入组达82.1%(23/28),而对照组仅为55.6%(20/36),2组有显著性差异(P<0.05)。介入组主要不良反应为脱发和口腔炎,对照组主要不良反应为胃肠反应。结论介入化疗后放疗与全身化疗后放疗对局部晚期鼻咽癌的近期疗效无差异,但局部肿瘤的完全消退率前者高于后者。

Objective To compare the short term effects of chemotherapy through different approaches combined with radiotherapy in the treatment of local advanced nasopharyngeal carcinoma(NPC).Methods 68 patients with local advanced nasopharyngeal were assigned to receive either DDP+5-Fu intraarterial chemotherapy through ascending pharyngeal artery or superior maxillary artery with Seldinger's method(IC group,n=30),or i.v.DDP+5-Fu(control group,n=38).Both the two groups received ~60 Co Radiotherapy with the same time and dose splitting one week after the second cycle of chemotherapy.Results The total response rate and CR were 100.0% and 80.0%(24/30) for IC group,and 100.0% and 78.9%(30/38) for control group respectively(P>~0.05 ).3～6 months later,the complete tumor regression rate under CT scan in the nasopharynx was 82.1%(23/28) in IC group,compared with 55.6%(20/36) in control group(P<0.05).The major adverse effects were alopecia and mucositis in IC group and gastrointestinal troubles in control group.Conclusion No marked difference is found in the short-term effects between the intraarterial and systemic chemotherapy,but the complete regression rate is higher with the intraarterial chemotherpy.