局部晚期鼻咽癌同步化疗与诱导化疗联合调强放疗的疗效分析

Outcome of clinical study of comparing chemotherapy neoadjuvant or concurrently with intensity-modulated radiotherapy for local advanced nasopharyngeal carcinoma

目的比较同步化疗与诱导化疗联合调强放疗治疗局部晚期鼻咽癌的疗效和毒副反应。方法将60例局部晚期鼻咽癌患者随机分为诱导化疗联合调强放疗组30例(诱放组)与同步化疗联合调强放疗组30例(同放组)。两组放疗方法相同,均采用调强放疗。鼻咽癌原发病灶(GTV1)给予70Gy,2.10～2.25Gy/次;达诊断标准的颈部淋巴结(GTV2)给予65～68Gy,2.0～2.18Gy/次;高危预防区(CTV1)给予60～62Gy,1.8～2.0Gy/次;低危预防区(CTV2)给予50.4Gy,1.8Gy/次。化疗方法为紫杉醇150mg/m2d1,顺铂90mg/m2(每日30mg/m2)d2～4。诱放组为先诱导化疗两周期+放疗+辅助化疗两周期。诱导化疗为每21天1周期。同放组为先同步放化疗+辅助化疗两周期。同步化疗为每28天1周期。两组辅助化疗均为每28天1周期。结果中位随访时间46个月。诱放组与同放组5年总生存率,无复发生存率,无转移生存率分别为59.1%和74.5%(χ2=0.24,P=0.624),40.4%和74.5%(χ2=1.959,P=0.162),35.6%和74.5%(χ2=2.491,P=0.114)。毒性反应观察:同放组发生3～4级口腔黏膜反应为53.3%,诱放组为36.7%(P=0.032),同放组发生骨髓抑制率为50.0%,诱放组为20.0%(P=0.024),同放组的副作用明显要高于诱放组。结论同步放化疗和诱导化疗+放疗这两种治疗方法对于局部晚期鼻咽癌特别是T3～4N0～3的患者在总生存率、无复发生存率和无转移生存率上无统计学差异。同放组较诱放组治疗毒性反应大,但能耐受。

Objective To compare neoadjuvant chemotherapy with concurrent chemotherapy for outcome,toxicities of local advanced nasopharyngeal carcinoma.Methods Sixty loco-regional advanced nasopharyngeal carcinoma were randomized into neoadjuvant chemotherapy＋radiotherapy＋adjuvant chemotherapy arm and concomitant chemoradiotherapy＋adjuvant chemotherapy arm.Thirty cases were enrolled into every arm.They were all applied in intensity modulated radiotherapy.The dose of nasopharyngeal tumor（GTV1） was prescribed to 70Gy,2.10~2.25Gy/fraction.The dose of involved lymphnode（GTV2）was given to 65~68Gy,2.0~2.18Gy/fraction.High risk and low risk prophylactic area received 60~62Gy,1.8~2.0Gy/fraction and 50.4Gy,1.8Gy/fraction,respectively.Neoadjuvant chemotherapy included paclitaxel 150mg/m2 d1 and cisplatin 90mg/m2（30mg/m2 everyday）d2~4 for two 21-day cycles.The same regimen at equal dosage was given on the 1st and 28nd days of the radiotherapy as concurrent chemotherapy.After radiotherapy 2 cycles of adjuvant chemotherapy were administered to both arms for two 28-day cycles.Results The median duration of follow-up was 46 months.The 5-year overall survival,relapse-free survival and metastasis-free survival rates were 59.1% and 74.5%（χ2=0.24,P=0.624）,40.4% and 74.5%（χ2=1.959,P=0.162）,35.6% and 74.5%（χ2=2.491,P=0.114）.Among the toxicities,the rates of grade 3/4 mucositis 36.7% and 53.3%（P=0.032）,leukopenia 20.0% and 50.0%（P=0.024）were significantly higher in concurrent chemoradiotherapy arm.Conclusion There is no significance in overall survival,relapse-free survival and metastasis-free survival between neoadjuvant chemotherapy and concurrent chemoradiotherapy arms.The two arms are tolerant despite more severe acute toxicities is observed in concomitant chemoradiotherapy arm.