局部及区域晚期鼻咽癌调强放疗同期PF和TP化疗比较研究

A comparative study of intensity-modulated radiotherapy with concurrent PF or TP chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma

目的比较调强放疗（IMRT）同期PF（奈达铂加氟尿嘧啶）、TP（紫杉醇加奈达铂）化疗治疗局部及区域晚期鼻咽癌的疗效及急性不良反应。方法回顾分析本院2009--2010年间收治的152例Ⅲ、Ⅳa期患者资料，其中80例IMRT同期PF化疗，72例IMRT同期TP化疗，两组患者总化疗疗程至少为2个周期。Kaplan-Meier法计算生存率并Logrank法检验，X2检验两组急性不良反应。结果随访率100％。IMRT同期PF和TP化疗组2年无复发生存率、无远处转移生存率、无进展生存率、疾病相关死亡率分别为95％和97％、82％和83％、81％和79％、13％和12％（X2=0．03、0．02、0．62、0．22，P=0．861、0．881、0．431、0．638）；≥3级白细胞减少、≥3级中性粒细胞减少、≥3级血小板减少、I〉2级肝功能损害、≥3级口腔黏膜炎发生率分别为33％和60％、23％和47％、14％和28％、8％和18％、12％和25％（X2=11．33、10．29、4．59、3．94、3．94，P=0．001、0．001、0．032、0．047、0．047）。结论IMRT同期TP方案较PF方案化疗在鼻咽癌中并未显示出生存优势，且不良反应更高。

Objective To investigate the survival data and acute toxicities in patients with locoregionally advanced nasopharyngeal carcinoma who receive intensity-modulated radiotherapy （ IMRT ） with concurrent chemotherapy using nedaplatin plus 5-fluorouracil （PF） or taxol plus nedaplatin （TP）. Methods A retrospective analysis was performed on the clinical data of 152 patients with stage m or IVa nasopharyngeal carcinoma who were admitted to our hospital in 2009--2010. Of the 152 patients, 80 received IMRT with concurrent PF chemotherapy, and 72 received IMRT with concurrent TP chemotherapy; there were at least 2 cycles of concurrent chemotherapy in both groups. The Kaplan-Meier method was used to calculate the survival rates, and the log-rank test was used to analyze the survival difference;the chi- square test was used to compare the acute toxicities in the two groups. Results The follow-up rate was 100%. The 2-year relapse-free survival rate, distant metastasis-free survival rate, progression-free survival rate, and disease-specific death rate for the IMRT/PF group were 95%, 82%, 81%, and 13%, respectively, versus 97% , 83% , 79%, and 12% for the IMRT/TP group （ X2 = 0. 03, 0.02, 0. 62, and 0.22, P= 0. 861, 0. 881, 0.431, and 0. 638）. The incidence rates of leukopenia （ grade ≥ 3 ）, neutropenia （ grade ≥ 3 ）, thrombocytopenia （ grade ≥3 ）, ALT elevation （ grade ≥ 2 ）, and oral mucositis （grade≥3） for the IMRT/PF group were 33%, 23%, 14%, 8%, and 12%, respectively, versus 60%, 47% , 28% , 18%, and 25% for the IMRT/TP group （X2 = 11.33, 10. 29, 4. 59, 3.94, and 3.94, P = 0. 001,0. 001, 0. 032, 0. 047, and 0. 047 ）. Conclusions Compared with IMRT with concurrent PF chemotherapy, IMRT with concurrent TP chemotherapy does not lead to significantly better survival and results in more acute toxicities in the patients with loeoregionally advanced nasopharvngeal carcinoma.