同期放化疗治疗局部晚期鼻咽癌的前瞻性研究

Prospective Study of Concurrent Chemotherapy and Radiotherapy for Advanced Nasopharyngeal Carcinoma

目的：观察同期放化疗治疗晚期鼻咽癌的疗效。方法：170例晚期鼻咽癌患者随机分为单纯放疗组（A组）90例和同期放化疗组（B组）80例。放疗组行常规放疗,原发灶剂量70Gy/7周,颈部给予双锁骨上野预防照射50Gy/5周,淋巴结转移阳性者局部追加至（60~70）Gy/（6~7）周。放化组放疗第1周和第6周同期应用PF方案化疗两周期。化疗方案为：顺铂（DDP）12mg/（m2.d）,1~5d,亚叶酸钙（CF）200 mg/（m2.d）,1~5 d,5-氟脲嘧啶（5-Fu）500 mg/（m2.d）,1~5 d,放疗结束后间隔28 d重复应用1~2周期化疗。结果：单放组CR15例,PR37例,总有效率（CR＋PR）57.8%;放化组CR21例,PR40例,总有效率（CR＋PR）76.2%。放化组有效率（76.2%）高于单放组（57.8%）,两者差异有统计学意义（P〈0.05）。单放组和放化组1年生存率分别为86.7%（78/90）和88.8%（71/80）,两者比较P〉0.05,差异无统计学意义;3年生存率分别为44.4%（40/90）和58.8%（47/80）,两者比较P〈0.05,差异具有统计学意义。放化组各项不良反应发生率均高于单放组,但对症处理后患者均可耐受。结论：同期放化疗能提高晚期鼻咽癌患者的局部控制率和生存率,毒副作用可以耐受,具有一定临床价值。

Objective：To evaluate the efficacy of concurrent chemotherapy and radiotherapy for advanced nasopharyngeal carcinoma.Methods：170 patients of advanced nasopharyngeal carcinoma were randomized into radiotherapy alone group（A group,90 patients）or concurrent chemotherapy group（B group,80 patients）.Radiotherapy group received conventional radiotherapy.The dose at the primary lesion were usually 70Gy/7weeks and 50Gy/5weeks was used prophylactically for the neck region which had been from metastasis.Metastasis positive local was supplementary to（60～70）Gy/（6～7）weeks.During the one weeks and six weeks of B group,two chemotherapy cycles of PF was used concurrently.The chemotherapy programme included cisplatin（DDP）12mg/（m2·d）,1～5d,Leucovorin（CF）200 mg/（m2·d）,1～5d and 5-fluorouracil（5-Fu）500mg/（m2·d）,1～5d.28 days later,one or two cycles of chemotherapy was repeated.Results：In group A,15 cases obtained complete remission,37 cases obtained partial remission and the total efficacy was 57.8%;In group B,21 cases obtained complete remission,40 cases obtained partial remission and the total efficacy was 76.2% and two groups had significant difference（P〈0.05）.The 1-year survival rates of Group A and B were 86.7%（78/90）and 88.8%（71/80）respectively and the difference was not statistically significant（P〉0.05）.The 3-year survival rates were 44.4%（40/90）and 58.8%（47/80）and two groups had significant difference（P〈0.05）.Group B of the adverse reaction rates were higher than those in Group A,but patients with symptomatic treatment can be tolerated.Conclusion：Concurrent radiotherapy and chemotherapy in patients with advanced nasopharyngeal carcinoma can improve the local control rate and survival rate,side effects can be tolerated and has clinical value.