放疗同期卡莫氟化疗治疗局部中晚期鼻咽癌疗效评价

Effect of radiotherapy concomitant to chemotheray in local napharyngeal carcinoma

探讨联合应用诱导化疗和放疗同期口服卡莫氟治疗局部中晚期鼻咽癌的疗效及不良反应。将收治的70例局部中晚期鼻咽癌患者随机分为诱导化疗后放疗组(对照组)和诱导化疗后放疗同期卡莫氟治疗组(治疗组)两组,两组均为35例,两组患者放疗前均接受2个疗程诱导化疗,治疗组在放疗期间同时口服卡莫氟。鼻咽肿瘤及颈部淋巴结完全消退率治疗组明显高于对照组,P<0.05。3和5年内局部复发率治疗组明显低于对照组,分别是11.4%、22.9%和34.3%、48.6%,差异有统计学意义,P<0.05。3年生存率治疗组和对照组分别是77.1%和51.4%,P<0.05。初步研究结果提示,放疗同期口服卡莫氟治疗局部中晚期鼻咽癌,降低了鼻咽和颈部肿瘤完全消退的照射剂量,提高了鼻咽和颈部肿瘤的完全缓解率,抑制或延缓肿瘤复发和远处转移,尽管患者的不良反应加重,但可以耐受。其远期疗效有待于进一步证实。

The objective of this study was to study the impact on the lecoregional control and metastasis and acute toxicity in patients with nasopharyngeal carcinoma（NPC） who were treated with two cycles of induction chemotherpy（ICT） followed by radical radiotherapy alone （RT） and radiotherapy concomitant to HCFU chemotherapy （RTCHC）. Seventy patients with stag Ⅲ and Ⅳ NPC were recruited onto two randomized trials. Half of them for RT, and half for RTCHC. Both were treated with two cycles of ICT follwed by RT and RTCHC. The complete rexponse rates in the nasopharynxe and the cervical mestasises were higher in RTCHC than in RT（P〈0.05）. The 3-year, 5-year local relapse rates were 11.4%, 22.9% in RTCHC and 34.3%, 48.6% in RT（P〈0.05）, respectively. Conclusions： Induction chemotherapy followed by radiotherapy concomitant HCFU is effective in the patients with local advanced NPC, and it can increase radiosensitivity and inhibit or delay relapse and distant metastasis so to improve the survival period of nasopharyngea carcinoma. Although the acute toxicity in the patients receiving RTCHC was aggravated, but it was endurable. The long term effect deserves further investigation in prospective trials