顺铂、氟脲嘧啶化疗及放疗对局部晚期鼻咽癌的临床观察

Clinical Observation on Patients with Locally Advanced Nasopharyngeal Carcinoma Treated by Chemotherapy with CDDP and 5FU Combined with External Beam Irradiation

（目的）探讨顺铂、氟脲嘧啶化疗综合放疗治疗局部晚期鼻咽癌的疗效。（方法）87例病理证实的Ⅲ、Ⅳa期鼻咽癌进行随机分组观察，45例采用综合治疗（治疗组），42例采用单纯放疗（对照组）。两级的照射方法和剂量相同。治疗组化疗：顺铂100mp／m2，第1天静脉注射，氟脲嘧啶750mg／m2，第1～5天静脉注射；于放疗前1周和放疗40Gy时以及放疗结束2～4周后进行。（结果）鼻咽部原发肿瘤消退率：治疗组95．6％，对照组81％（P＜0．05）。颈淋巴结完全消退率：治疗组93％、对照组74％（P＜0．05））。治疗组2、3、4年生存率分别为82．2％、75．5％、66，6％，对照组分别为61．9％、54．8％、47．7％（P＜0．05）。治疗组2、3、4年局控率分别为778％、68．9％、622％，对照组分别为57．2％、476％、40％（P＜0．05）。治疗组出现远处转移的中位时间18.6个月，对照组7．9个月，两组比较差异显著（P＜0．05）。（结论）顺铂、氟脲嘧啶化疗加放疗有助于改善肿瘤的消退率、局部控制率、延长出现远处转移的时间，提高局部晚期鼻咽癌患者的生存率，其毒副反应可以耐受。

[Purpose] The effect of chemotherapy with CDDP and 5FU combined with external beam irradiotion(EBI) for the locally advanced nasopharyngeal carcinoma(NPC) were evaluated. [Methods] From Oct.1993 to Oct. 1995, 89 patients with thelocally advanced NPC were ramdomized divided into two groups. The trial group(TG) with 45 patients received chemotherapy andEBI. The control group(CG) with 42 patients were treated by EBI alone. The method of EBI, fractions and dose of two groupswere just the same. Chemotherapy regimen consisted of CDDP 100mg/m2, iv, on the first day and 5FU 750mg/m, iv, per day×5 days for three courses in the first week before EBI, the fifth week during EBI and two to four weeks after the finishing EBI. [Results] The response rate of nasopharyngeal neoplasms was 95. 6%(43/45) in TG and 81 %(34/42) in CG(P<0.05). The complete remission rate of cervical lymph nodes was 93%(42/45) in TG and 74(31/42) in CG(Pr0. 05). The 2-year, 3-year and 4-year survival rates were 82. 2%, 75. 5%, 66. 6% in TG, and 61. 9%, 54. 8%, 47. 7% in CG(P<0.05) respectively. The localcontrol rates for 2-year, 3-year and 4-year were 77. 8%, 68. 9% and 62. 2% in TG and 57. 2%, 47. 6% and 40% in CG(P<0.05) respectively. The median time of occursing distant metastasis was 18. 6 months in TG and 7. 9 months in CG(P<0.05).[Conclusion] The remisson of nasopharyngeal neoplasms, local control rate and the survival rate for the locally advanced NPCcould be improved by chemotherapy with CDDP and 5FU combined with EBI. The median survival tinle of occuring distant metas-tasis will be extended. The toxicity of chemotherapy is tolerable for the patients.