新辅助化疗与放疗间断对鼻咽癌总生存的影响

Intensive Neoadjuvant Chemotherapy and a Break in Radiation Treatment May Have a Significant Impact on Overall Survival of Patients with Nasopharyngeal Carcinoma

目的:探讨较强烈的新辅助化疗和放疗间断对鼻咽癌患者长期生存的影响。方法:选取1995年1月至1998年12月福建省肿瘤医院1706例鼻咽癌患者接受或不接受新辅助化疗,1081例患者单纯放疗,而625例接受1个疗程较强烈的新辅助化疗。化疗方案以DDP为基础,每14天为1个周期,多为2～3个周期,放疗在最后一次化疗结束后2～5天开始。化疗包括:DDP80mg/m^2分3天(d1～d3)静脉推注;5-FU 750mg/(m^2·d),连续5天(d1～d5)静脉滴注。1706例患者中有177例患者由于各种原因造成放疗间断1周以上。分析患者、肿瘤和治疗等因素对长期生存的影响,尤其是新辅助化疗和放疗间断对生存的影响。结果:中位随访时间75个月(6～126个月),失访162例,随访率为90.50%。3年和5年生存率分别为79.2%和67.6%。多因素分析显示性别、年龄、治疗前贫血、肿瘤分期、是否采用新辅助化疗以及放疗是否间断等是影响长期生存的独立预后因素。Ⅰ、Ⅱ、Ⅲ和Ⅳ期的5年生存率分别为100.0%、75.9%、66.5%和49.3%(P<0.05)。Ⅲ/Ⅳ期患者中接受与不接受辅助化疗的5年总生存率分别为65.3%(95%CI:0.796～0.869)和60.5%(95%CI:0.755～0.824)(P=0.041)。放疗间断与放疗不间断的5年总生存率分别为51.69%(95%CI:0.449～0.584)和69.45%(95%CI:0.672～0.717)(P<0.001)。结论:较强烈的新辅助化疗和放疗过程的不间断是鼻咽癌患者长期生存的有利因素。

Objective： To study whether intensive neoadjuvant chemotherapy and a break in radiation treatment have a significant impact on survival in patients with nasopharyngeal carcinoma （NPC） treated with radiotherapy. Methods： This study was a retrospective review of 1,706 patients with NPC treated with radiotherapy with or without chemotherapy at a single institution and between January 1995 and December 1998. There were 1,081 patients treated with radiotherapy alone and there were 625 who also received an intensive course of neoadjuvant chemotherapy. Chemotherapy, if given, was cisplatin-based, given every 14 days for 2-3 cycles. The chemotherapy regimen consisted of cispiatin 80 mg/m^2 by rapid Ⅳ infusion given on 3 consecutive days （days 1 to 3） and 5-FU 750 mg/m^2/day by IV infusion on days 1 through 5. Radiotherapy normally started within 2-5 days of completion of the last cycle of chemotherapy. A total of 177 out of 1,706 patients had a radiation-free period lasting more than one week. Patient, tumor and treatment factors were analyzed for their significance on long term overall survival （OS）. Researchers analyzed whether intensive neoadjuvant chemotherapy and a radiation-free period had a significant impact on survival in patients with nasopharyngeal carcinoma （NPC）. Results： The median follow-up was 75 months （range 6 to 120 months）. The follow-up rate was 90.50% with 162 of the patients not completing follow-up. The 3- and 5-year OS rates were 79.2% and 67.6%, respectively. Multivariate analysis showed that gender, anemia, tumor stage （T stage, N stage, M stage and TNM stage）, chemotherapy and radiation-free periods were independent significant factors （P〈0.05） associated with long-term survival. The 5-year OS rates were 100%, 75.9%, 66.5% and 49.3% for stages Ⅰ, Ⅱ, Ⅲ and Ⅳ （P〈0.05）; the 5-year OS rates were 65.3% （95% CI 79.64%-86.94%） and 60.5% （95% CI 75.47%-82.4%） for stage Ⅲ/Ⅳ patients treated with or without neoadjuvant chemotherapy （P=0.041）; the 5-year OS rates were 51.7% （95% CI 44.95%-58.43%） and 69.5% （95% CI 67.24%-71.66%） for patients with or without a treatment break （P〈0.001）, respectively. Conclusion： Intensive neoadjuvant chemotherapy and continuous radiation treatment seem to be favorable factors associated with long term survival in patients with NPC.