局部晚期鼻咽癌300例放射化学治疗远期效果分析

Long-term effect of radiochemistry on 300 patients with local advanced nasopharyngeal carcinoma

目的观察局部晚期鼻咽癌放射治疗联合诱导和（或）同步化学治疗的疗效和副反应，分析影响生存率和局部控制率的预后因素。方法共收集1995年1月至1998年12月在福建省肿瘤医院接受化学治疗联合放射治疗的Ⅲ～Ⅳa期初治鼻咽癌300例，其中诱导化学治疗94例（31．1％），同步化学治疗64例（21．3％），诱导化学治疗＋同步化学治疗142例（47．3％）。所有患者均采用常规分割外照射，放射线采用^60Co伽玛线或6Mv-X线，原发灶中位剂量72Gy，23例患者外照射后补充后装治疗。化学治疗方案均采用5-氟尿嘧啶＋顺铂。中位随访时间为79个月。主要随访观察指标：急性副反应、远期并发症、生存期、生存率、无远处转移生存率及局部控制率。结果早期反应主要为白细胞下降和口腔黏膜炎，严重晚期副反应主要为后组颅神经损伤。全组患者5a总生存率、原发灶控制率（局部控制率）、区域淋巴结控制率（区域控制率）和无远处转移生存率分别为67．7％、94．6％、94．3％和72．4％。单因素分析显示T分期、N分期、临床分期及化学治疗方式是影响生存的预后因素（P〈0．05）。多因素分析只有化学治疗方式是影响生存的独立预后因素（P〈0．05），诱导化学治疗加同步化学治疗患者的生存率和局部控制率均明显好于单纯诱导化学治疗和同步化学治疗者（P〈0．05）。但化疗方式并不影响远处转移率。结论放射治疗联合应用化学治疗对局部晚期鼻咽癌疗效理想，耐受性好。诱导加同步化学治疗疗效最好，但需要大规模前瞻性研究进一步证实。

Objective To evaluate the long-term effect and side effect of radio-chemotherapy in treatment of local advanced nasopharyngeal carcinoma, and to analyze the prognostic factors of survival and local control. Methods During the period of January 1995 to December 1998, 300 newly diagnosed, stage Ⅲ -Ⅳa nasopharyngeal carcinoma patients were treated with radiochemotherapy in Fujian Provincial Tumor Hospital. Among these patients, 94（ 31.1% ） received induction chemotherapy, 64（21.3% ） received radiochemotherapy concomitantly and 142（47.3% ） received both induction and synchronal chemotherapy. All chemotherapy regimen was DDP plus 5-Fu. The median radiation dose was 72Gy to the GTV. Results The most early side effects were myelosuppression and mucositis, and the late side effects was Injury of cranial nerve. The 5-year overall survival, primary site control, regional node control and metastases free survival was 67.7%, 94.6% ,94.3% and 72.4% respectively. In univariate analysis, T stage, N stage, TNM stage and chemotherapy modality were significant factors for survival （P 〈 0.05 ）. After the adjustment of multivariate analysis, only chemotherapy modality was an independent predictor both for survival（ P 〈 0.05 ） and local control （ P 〈 0.05 ）. Conclusion Combined radiotherapy and chemotherapy is an effective and well-tolerated treatment method for local advanced nasopharyngeal carcinoma. Induction chemotherapy plus radio-chemotherapy concurrently consult the best result and warrant more further investigation.