顺铂加氟尿嘧啶诱导化疗加同步放化疗在局部中晚期鼻咽癌治疗中的应用

Application of induction PF chemotherapy plus concurrent chemo-radiotherapy in patients with locoregional advanced nasopharyngeal carcinoma

目的探讨顺铂（DDP）＋氟尿嘧啶（5-FU）诱导化疗联合同步放化疗治疗局部中晚期鼻咽癌的有效性及安全性。方法42例局部中晚期鼻咽癌患者纳入研究，给予PF方案（DDP20mg／m2，第1～5天；5-FU750mg／m2，第1—5天）诱导化疗，每3周为1个疗程，2个疗程结束后1周开始放疗，放疗治疗中予以相同方案化疗2个疗程。观察患者的临床疗效和毒副反应。结果所有患者均完成了计划剂量的治疗。诱导化疗结束后，鼻咽癌完全缓解率为21．4％，颈淋巴结完全缓解率为33．3％；治疗后3个月，鼻咽癌完全缓解率为97．6％，颈部淋巴结完全缓解率为94．4％。以PF方案行诱导化疗患者耐受性好，同期放化疗期间，35．7％患者发生了Ⅲ度黏膜炎，16．7％患者发生了Ⅲ度呕吐反应，骨髓抑制以Ⅱ度多见，其他不良反应有脱发、口干等。中位随访时间为15个月，随访期内无死亡病例，两年累计局部复发2例，远处转移1例。结论DDP＋5-FU诱导化疗联合同步放化疗治疗局部中晚期鼻咽癌患者耐受性好，鼻咽癌原发灶和颈淋巴结转移灶完全缓解率高。

Objective To investigate the efficacy and safety of induction chemotherapy （DDP ＋ 5-FU） followed by concurrent chemo-radiotherapy （CCRT）in patients with locoregional advanced nasopharyngeal carcinoma （NPC）. Methods 42 patients with locoregional NPC were enrolled in the study. Before CCRT, patients were assigned to receive two cycles of chemotherapy（ DDP 20mg/m2 d1- 5 ;5-FU 750mg/m2 d1 - 5 ） every three weeks. Then the same chemotherapy was given from the first day of standard radiotherapy. Results All patients completed planned treatment and were eligible for toxicity and response analysis. After induction chemotherapy,9 patients achieved complete response in nasopharynx and 12 patients achieved CR in regional nodes ;Three months after radiotherapy ,41 patients achieved CR in nasopharynx and 34 patients achieved CR in regional nodes. Induction PF was well tolerated and the most common acute high-graded toxicity of CCRT was grade III mueositis （ 35.7% ） and grade III vomiting （ 16.7% ）. At median follow-up of 15 months, the overall survival rate was 100%, two-year cumulative local recurrence rate was 4.8% and distant metastasis rate was 2.4%. Conclusion Induction PF chemotherapy plus concurrent chemo-radiotherapy was tolerable and satisfactory for patients with locoregional NPC.