同期放化疗治疗中晚期鼻咽癌的疗效分析

Clinical Effect of Concurrent Chemoradiotherapy on Patients with Advanced Nasopharyngeal Carcinoma

【目的】观察同期放化疗治疗中晚期鼻咽癌(Ⅲ或Ⅳa期)的疗效。【方法】128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64例。两组放疗方法相同,为常规分割剂量。A组在放射治疗的第1、5周给予2个周期顺铂+氟尿嘧啶方案化疗;B组只给单纯放射治疗。【结果】所有病人均顺利完成治疗方案。A组与B组治疗结束时鼻咽原发灶消退率分别是93.75%(60/64)、73.44%(47/64);颈淋巴结消退率分别是100%(64/64)、89.06%(57/64);A组1、3、5年生存率分别为96.88%(62)、76.56%(49)、54.69%(35);B组1、3、5年生存率分别为90.63%(58)、45.31%(29)、32.81%(21),差异有显著性(P<0.05)。毒副作用:A组胃肠道反应、骨髓毒性高于B组(P<0.05);两组口腔黏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,降低远处转移和提高5年生存率,其毒性反应可以耐受,不影响放疗的顺利完成,值得在临床中推广。

[Objective] To evaluate the effect of radiotherapy combined with concurrent chemotherapy for the treatment of advanced nasopharyngeal carcinoma. [Methods] One hundred and twenty eight cases with advanced nasopharyngeal carcinoma（stage Ⅲ and Ⅳa）were randomized into two groups. Group A received radiotherapy with concurrent chemotherapy（ n = 64） consisted of cisplatin（DDP, 60 mg/m^2 ,days 1-5） and 5-fluorouracil（5-Fu, 500 mg/ m^2 , days 1 - 5）, followed by another treatment in 5th week. Group B received radiotherapy alone （ n = 64）. In all cases, radiotherapy followed the same protocol. [Results] All patients completed the treatment course,and the complete response rates of the primary lesions and cervical nodes in Group A and Group B were 93.75% （60/64）, 73.44 % （47/ 64） ,100%（64/64） and 89. 06%（57/64）（ P 〈0.05）,respectively. The 1-,3- and 5-year survival rate was 96. 88% （62） ,76. 56%（49） and 54.69%（35） in Group A and 90. 63%（58） ,45.31%（29） ,32.81%（21） in Group B, respectively. It was statistically significant difference between Group A and B. Gastrointestinal reaction and bone marrow toxicity in Group A were more severe than that in Group B（ P 〈0.05）. Oral mucosa and cutaneous reaction in two groups were the same. [Conclusion] Radiotherapy with concurrent chemotherapy can improve the elimination rate of the primary lesions , cervical nodes and the 5-year survival rate of advanced nasopharyngeal carcinoma and decrease the distant metastasis rate. The toxicity was tolerable and the treatment can be completed. Concurrent chemoradiotherapy was very effective and practicable for the treatment of advanced nasopharyngeal carcinoma, and it should be generalized.