晚期鼻咽癌同期放化疗临床疗效分析

Prospective Clinical Study of chemotherapy combined with radiotherapy in treatment of advanced nasopharyngeal carcinoma

目的观察单纯放疗和同期放化疗两种治疗方法对局部晚期鼻咽癌的临床疗效。方法将110例Ⅲ和Ⅳ鼻咽癌病人随机分为单纯放疗组（RT组）和同期放化组（CCRT组）分别为49和61例。放疗：两组病人均使用常规分割外照射，使鼻咽部剂量达到70-74Gy，颈部剂量达到60-66Gy。化疗：放疗前顺铂（DDP）30mg／d，第1-5天；氟脲嘧啶（5-FU）0.75g／d，第1-5天；CCRT组采用顺铂30mg／d，1次／周，共用3-5周期。结果CCRT组和RT组肿瘤全消率分别为86.9％和69.4％，两者比较有统计学意义（P〈0.05），淋巴结残留率分别为11.5％和28.6％，两者比较有统计学意义（P〈0.05）。远期疗效：CCRT组和RT组2、3、5年总死亡率分别为14.75％、19.67％、32.79％和22.45％、28.57％、42.86％，两组比较无统计学意义（P〉0.05），两组无事件生存率、局部复发率、远处转移率，CCRT组较RT发率低（P〈0.05），结论局部晚期鼻咽癌病人选用同期放化疗治疗，能明显改善患者的无事件生存率，降低局部复发率及远处转移率。

Objective To compare concurrent chemoradiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma （NPC）. Methods 110 patients with pathologically comfirmed low differentiated nasopharyngeal squamous cell carcinoma with Ⅲ and Ⅳ stage according to 92 FuZhou staging system were randomly allocated into CCRT group （61 patients） and RT group （49patients）. The dose at the primary lesion were usually DT 70-74 Gy/35-37 fractionationin 7-8 weeks. DT 60-66 Gy was used for the metastastic lymph node. Before radical radiotherapy patients of CCRT group received cisplatin （DDP） 30 mg on days 1-5 and fluorouracil （5-FU） 0.75 g on days 1-5 . The patients in the CCRT group received Cisp latin 30 mg/d once a week during 3-7 weeks of radiotherapy. Results Complete response rate and locoregional remain rate of the CCRT group and RT group three months after treatment were 86.9% and 69.4% , 11.5% and 28.6% respectively, there were significant difference between the two groups （P〈0.05）. After a median follow-up 38 months, event-free survival（EFS） , loeoregional control rate （LRR） and distantmetastasis rate （DMR） of the CCRT group and RT were compared respectively, there were significant difference between the two groups （P〈0.05）. The 2, 3 and 5 year OS rate was 14.75% ,19.67% ,32.79% and 22.45% ,28.57% ,42.86%, The OS were not significant different statistically between the two groups （P〉0.05）. Conclusion Adding chemotherapy to radiotherapy improves LRR and reduces DMR and EFS of patients with nasopharyngeal carcinoma.