2种化疗方案诱导联合同期放化治疗鼻咽癌的近期疗效评价

Assessment of two kinds of chemotherapy combined respectively with radiotherapy on nasopharyngeal carcinoma in short-term

目的:比较2种化疗方案诱导联合同期放化治疗鼻咽癌的依从率、毒副作用和近期疗效。评价2种化疗方案在该治疗模式的可行性。方法:采用前瞻性非随机对照研究。化疗方案:CbF组36例,卡铂50mg/m2第1～5天,5-氟尿嘧啶750mg/m2第1～5天;PF组38例,顺铂20mg/m2第1～5天,5-氟尿嘧啶750mg/m2第1～5天,均为每3周重复,共3个周期,于放疗前第1周给予第1周期诱导化疗。放疗方案:采用鼻咽癌常规放疗标准方案,应用10MV-X和10MeV-β或12MeV-β外照射,NPTD64～80Gy、颈淋巴结(+)TD64～70Gy、颈淋巴结(-)TD40～50Gy,2Gy/次,5次/周。结果:第2、3周期化疗依从率,CbF组:77.8%和16.7%(P=0.00),PF组:84.2%和42.1%(P=0.00),且组间比较P=0.48和P=0.03;鼻咽、颈淋巴结(+)的实际照射时间和理论照射时间,CbF组:(56±5)d和(52±2)d(P=0.00)、(46±6)d和(42±4)d(P=0.00),PF组:(53±6)d和(50±3)d(P=0.07)、(42±5)d和(42±3)d(P=0.97);3度以上毒副作用:CbF组与PF组口腔、咽黏膜反应分别为63.9%和13.2%(P=0.00),放射性皮炎、骨髓抑制、胃肠反应、肝肾功能毒性比较均为P>0.05。近期疗效:CBF组和PF组的鼻咽肿瘤、颈淋巴结(+)的CR率分别为86.11%和89.47%(P=0.93)、77.78%和90.00%(P=0.37),但TD≤50Gy阶段,颈淋巴结(+)的CR率分别为36.66%和11.11%(P=0.03)。放化疗后CbF组和PF组患者中位随诊17个月局部区域残留、复发及远处转移率比较均相似(P>0.05)。结论:CbF和PF化疗方案在该治疗模式的化疗依从性差,但具有高度肿瘤完全消退率。化、放疗依从性、毒副作用和近期疗效PF组显示出一定优势。

Objective： To compare the short-term effects of two kinds of chemotherapy combined respectively with radiotherapy on nasopharyngeal carcinoma, compliance of patients and toxicity ; to evaluate the feasibility of this two methods in the treatment model. Methods： A prospective non-randomized control study was designed. Patients were divided into group A （36 cases） and group B （38 cases）, patients in group A underwent chemotherapy using CbF, 50 mg/m^2 earboplat for 1 - 5 days, 5 - fluorouracil 750 mg/m^2 for 1 - 5 days, and patients in group B underwent chemotherapy using PF, cisplatin 20 mg/m^2 for 1 - 5 days, 5 - fluorouracil 750 mg/m^2 for 1 - 5 days, repeated every 3 weeks for three cycles. First cycle of induction chemotherapy was practiced first week before radiotherapy. Standard conventional radiotherapy for nasopharyngeal carcinoma was used, external exposure with 10MV-X and IOMeV-β or 12MeV-β, NPTD 64 N 80 Gy, neck lymph node （ ＋ ） TD 64 - 70Gy, cervical lymph node （-） TD 40 - 50 Gy, 2 Gy/time, 5 times/week. Results： The chemotherapy compliance rates of group A and group B in the second and third week were 77.8% vs 84.2% and 16.7% vs 42.1% respectively （P = 0.00）, and inter-group comparison ： P = O. 48 and P = 0.03. The actual and theoretic exposure time of nasopharynx and cervical lymph node （ ＋ ）in different group were： group A： （56 ±5 ） d and （52 ± 2） d （P = 0.00）, （46± 6） dand （42 ± 4 ） d （P = 0.00） group B： （53± 6） d and （50 ±3） d （P=0. 07）, 4 （2 ＋ 5 ） d and （42 ± 3） d （P = 0.97）. Degree 3 and above side effects： oral and pharyngeal mucosal reactions in group A and B were 63.9% and 13.2% respectively（P = 0.00） ; the differences of incidences of radiation dermatitis, bone marrow suppression, gastrointestinal reactions, and impairment of liver and kidney functions between the two groups were all insignificant（ P 〉0.05） Short-term effects： CR rates of nasopharyngeal cancer and cervical lymph node （ ＋）in group A and B were 86.11% and 89.47% （P= 0.93）, 77.78% and 90.00% （P =0.37） respectively, but for TD ≤ 50 Gy region, CR rate of cervical lymph node （ ＋ ） was 36.66% and 11.11% respectively （P = 0.03）. The differences of incidences of local residue and relapse, distant metastasis between the two groups were similar （P 〉 0.05 ） according to median 17 months follow-up after radiotherapy and chemotherapy. Conclusion： For both CbF and PF chemotherapy, compliance of patients was poor and rate of tumor regression was high; patients underwent PF chemotherapy and radiotherapy have advantages over CbF at compliance, side effects and short-term effects.