同期放化疗联合辅助化疗对比同期放化疗治疗局部区域晚期鼻咽癌的临床观察

Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma

目的:探讨同期放化疗联合辅助化疗治疗局部区域晚期鼻咽癌的疗效及其毒副反应。方法:共收集61例入组条件符合的鼻咽癌患者。采用常规分割放射治疗,200 cGy/次,1次/d,5 d/周。同期化疗随机采用顺铂30 mg,每周1次。观察组辅助化疗采用顺铂80 mg/m2+5-Fu 800 mg/m2,1～5 d,1次/4周,共3～4个疗程。结果:患者放化疗期间观察组和对照组发生3级以上急性治疗毒性反应分别为64.3%(18/28),33.3%(11/33),P<0.001。观察组和对照组两年总生存率分别为74.6%,78.8%(P>0.05)。两组2年无远处转移生存率分别为87.2%,87.9%(P>0.05)。两组2年无瘤生存率分别为83.9%,81.7%(P>0.05)。两组2年无局部区域复发生存率分别为92%,93%(P>0.05)。结论:使用PF方案辅助化疗治疗局部区域晚期鼻咽癌治疗毒性明显增高,然而并不能提高总生存率及降低无远处转移生存率。

Objective To evaluate the therapeutic effects and side effects of concurrent chemoradiotherapy plus adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma.Method From May 2008 to May 2010,61 patients with nasopharyngeal carcinoma were treated by platinum-based chemotherapy（cisplatin 30 mg weekly up to 7 weeks） and radiotherapy（given as 200 cGy per fraction with five daily fractions per week） in our department.The experimental group subsequently received 80 mg/m2 adjuvant cisplatin and 800 mg/m2 per day fluorouracil for day one to five every 4 weeks for three to four cycles.Results The Ⅲ~Ⅳ grade side effects induced by chemoradiotherapy was 64.3%（18/28） for the experimental group vs.33.3%（11/33） for the control group（P0.001）.The 2-year overall survival rate was 74.6% vs 78.8%（P0.05）,respectively.The 2-year disease-free survival（DFS） rate was 83.9% vs 81.7%（P0.05）,respectively.The 2-year distance metastasis free survival（DMFS） rate was 87.2% vs 87.9%（P0.05）,respectively.The 2-year local recurrence free（LRF） survival rate was 92% vs 93%（P0.05）,respectively.Conclusion Adjuvant cisplatin and fluorouracil chemotherapy made significantly higher side effects after concurrent chemoradiotherapy in locoregional advanced nasopharyngeal carcinoma and did not significantly improve the overall survival rate or lower the distance metastasis free survival rate.