顺铂、氟尿嘧啶为主方案同期放化疗在鼻咽癌治疗中的耐受性研究

Study on the tolerance of nasopharyngeal carcinoma (NPC) to cisplatin and fluorouracil based concurrent radio-chemotherapy

目的比较5-氟尿嘧啶(5-fluorouracil,5-Fu)+醛氢叶酸(leucovolin,CF) +顺铂(cisplatin,DDP)组成的PLF或DDP+5-Fu的PF方案化疗+同期放疗与单纯放疗治疗局部晚期鼻咽癌的耐受性及毒副作用。方法将62例在本院住院的病理证实的初治(Ⅲ期和Ⅳa期)鼻咽癌患者,按不同的治疗方法分成化疗+同期放疗组(32例)和单纯放疗组(30例)。治疗方法:同期放化疗组:PF 3周或PLF双周方案化疗3个疗程,放疗于化疗第1～14天开始。两组放疗条件相同,剂量相似。主要比较两组治疗期间的副作用及耐受性,其次观察两组的近期疗效、无病进展时间。结果同期放化疗组全部按计划完成化疗疗程者37.5%,另外31.25%的患者第2疗程后仅行DDP化疗,有31.25%的患者仅行1个疗程的化疗。放疗过程中因毒副作用而中断放疗4～7天者以放化疗组多见(P<0.005)。同期放化疗组发生Ⅲ～Ⅳ度的消化道反应、骨髓抑制、皮肤反应、口腔粘膜炎明显增高(P<0.05)。放疗结束时及放疗结束后3月,两组鼻咽和颈部肿瘤消退情况均无显著性差异(P>0.05)。同期放化疗组与单纯放疗组的无进展生存期分别为25个月和23个月(P>0.05)。结论顺铂和5 -氟尿嘧啶为主联合方案化疗与放疗同期治疗局部晚期鼻咽癌,毒副作用可能有叠加,患者耐受性下降,治疗依从性低,从而影响治疗效果,应谨慎使用。

To compare the tolerance and toxicity between radiotherapy combined with concurrent PLF （5 -Fu, CF and DDP） or PF （DDP plus 5 -Fu） chemotherapeutic regimens and simple radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma （NPC）. Methods Totally 62 inpatients with pathologically confirmed nasopharyngeal carcinoma （in stage Ⅲ and Ⅳa）, but without previous treatment history, were divided into two groups ： concurrent radio - chemotherapy group （ n = 32） and simple radiotherapy （ n = 30）. In the former group, patients received 3 cycles of either triweekly PF regimen or biweekly PLF regimen, combined with radiotherapy within 1 - 14d of chemotherapy. Both groups are identical in radiotherapy conditions and similar in radiotherapy doses. Results In theradio - chemotherapy group, 12 patients （37.5%） finished preplanned chemotherapy completely, 12 patients （31.25%） received only DDP chemotherapy after the second treatment cycle, and the rest 12 patients （31.25%） received one cycle of chemotherapy. During the radiotherapy process, a 4 -7d interruption of radiotherapy due to toxicity was predominately associated with radio-chemotherapy treated members （ P 〈0. 005）; it also showed significantly higher incidence of Ⅲ-Ⅳ gastrointestinal tract reaction, bone marrow depression, skin reaction, and oral mucositis （P 〈 0. 05）. At the end of radiotherapy and within 3 months following radiotherapy, there was no statistically significant difference in regression of the naso- pharyngeal and neck tumor between two groups （P 〉 0. 05 ）, and the progressive survival period was 25 months for the radio-chemotherapy group and 23 months for the simple radiotherapy group （P 〉 0. 05 ）. Conclusion Radiotherapy combined with DDP and 5-Fu based chemotherapeutic regimens should be used with caution in the treatment of locally advanced nasopharyngeal carcinoma （NPC） due to the potential toxicity accumulation, decreased tolerance, and poor treatment compliance.