诱导化疗在局部晚期鼻咽癌放射治疗中的价值

Value of induction chemotherapy followed by radiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma

目的 :评价诱导化疗对局部晚期鼻咽癌放射疗效的影响。方法 :12 7例病理确诊的Ⅲ、ⅣA期初诊鼻咽癌患者接受诱导化疗 (含顺铂为主的联合方案1～ 3个疗程 )加放射治疗 ,按TNM分期、性别、年龄、病理类型的匹配条件与同期12 7例单纯放疗患者配对进行比较 ,两组采用的放射治疗技术基本一致。结果 :化放组和单放组 3年远处转移率分别为10 2 %和 2 4 4% ,P =0 0 0 3 ,两组的 3年总生存率 (OS)、无瘤生存率 (DFS)、无远处转移生存率 (DMFS)、无复发生存率(RFS)分别为 78 1%和 67 4% ,P =0 0 85 ;72 1%和 63 1% ,P =0 0 47;88 1%和 72 1% ,P =0 0 0 1;84 9%和94 5 % ,P =0 10 5。对N2 ～N3 期患者 ,两组的OS、DFS、DMFS分别为 79 7%和64 9% ,P =0 0 2 7;74 6%和 60 2 % ,P=0 0 14 ;87 9%和 68 6% ,P =0 0 0 2。化放组化疗 2个疗程的 3年DFS要明显高于化疗 1个疗程 ( 83 1%对 65 7% ,P=0 0 49)或单纯放疗 ( 83 1%对 63 1% ,P =0 0 1)。结论 :诱导化疗综合放疗能明显降低局部晚期鼻咽癌患者的远处转移率 ,提高无瘤生存率 ,但不能提高局控率和总生存率 ;诱导化疗力度不足 ( <2个疗程 )

OBJECTIVE: To evaluate the value of induction chemotherapy (ICT) followed by radiotherapy (RT) compared with RT alone in patients with locoregionally advanced nasopharyngeal carcinoma (NPC).METHODS:From January to December in 1999, 127 patients, who were newly diagnosed and pathologically proven as NPC with Fuzhou′s Ⅲ and ⅣA stage, were treated by cisplatin-based ICT (given every 3- week for 1 to 3 cycles) plus RT in our center. These patients were compared with a cohort of 127 patients simultaneously treated by RT alone, who were matched with respect to T stage, N stage, gender, age and the pathological type. The RT techniques were similar in the two groups.RESULTS:The distant metastasis incidence was significantly lower in the IC/RT group compared with the RT group (10.2% vs 24.4%, P=0.003). The 3-year overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and relapse-free survival (RFS) rates for the ICT/RT group and the RT group were 78.1% vs 67.4% ,P=0.085, 72.1% vs 63.1% ,P= 0.047, 88.1% vs 72.1% ,P=0.001, and 84.9% vs 94.5%,P=0.105, respectively. For the patients of N 2-N 3 disease, the 3-year OS, DFS, and DMFS for the two groups were 79.7% vs 64.9%,P=0.027, 74.6% vs 60.2%,P=0.014, and 87.9% vs 68.6%,P=0.002, respectively. The patients undergoing 2 cycles of ICT had a higher DFS compared with 1 cycle of ICT (83.1% vs 65.7%, P=0.049) in the ICT/RT group or RT alone (83.1% vs 63.1%, P=0.01).CONCLUSIONS:ICT combined with RT significantly decreases incidence of distant metastases and improves disease-free survival in patients with locoregionally advanced NPC, but has no benefit for local regional control and OS. Deficiency of power of ICT (<2 cycles) will impact therapeutic effectiveness.