顺铂、氟尿嘧啶合用大剂量醛氢叶酸治疗晚期鼻咽癌

Cisplatin,fluorouracil and high dose leucovorin(HDCF) for advanced nasopharyngeal carcinoma(NPC)

对比观察大剂量醛氢叶酸 (CF)、5 氟尿嘧啶 ( 5 Fu)、顺铂 (DDP) (PFL方案 )与DDP + 5 Fu(PF方案 )联合化疗对晚期鼻咽癌的临床疗效及安全性。方法 :1 997年 1月— 1 999年 1月间 ,5 8例经病理证实的晚期鼻咽癌患者 ,非随机分为PFL组 2 8例 (按PFL方案化疗 ) ,PF组 30例 (按PF方案化疗 )。结果 :PFL组CR率、有效率分别为 1 7.9%、6 4 .3% ,中位生存期 1 4月 ( 4— 2 1月 )。PF组其CR率、有效率分别为 1 0 %、46 .7% ,中位生存期 1 1 .5月( 2 .5— 2 2 .5月 )。两组CR率及有效率、中位生存期无显著性差异 (P >0 .0 5 )。PFL及PF方案化疗对鼻咽肿物、颈部或腹部淋巴结转移、肺转移效果较好 ,对骨转移虽客观缓解率不高 ,但止痛效果较好 ,对肝转移效果较差。PFL组其WBC下降率有显著性差异 (P <0 .0 5 ) ,Ⅲ—Ⅳ级WBC下降率有非常明显的显著性差异 (P <0 .0 1 ) ;口腔炎、脱发的发生率有非常明显的显著性差异 (P <0 .0 1 ) ,其他毒性反应相似 (P >0 .0 5 )。结论

Purpose:To evaluate the activity and safety of PFL (HDCF+5 Fu+DDP) regimen and PF(DDP+5 Fu)regimen in advanced NPC. Methods:From 1997.1—1999.1, 58 cases of histologically proven advanced NPC were nonrandomly divided into 2 groups ,of whom 28 cases were treated with PFL regimen, 30 cases with PF regimen(contrast group). Results:complete response rate and respose rates (RR) of PFL regimen and PF regimen were 17.9%、64.3% respectively and 10% 、46.7% respectively , median survival duration(MSD) were 14 m(4—21m) and 11.5m(2.5—22.5m). There was no significant difference in CR rate and RR and MSD between the two groups(p>0.05). PFL and PF chemotherapy regimens for nasopharyngeal mass, metastasis of neck or abdomen lymphnode, metastasis of lung were effective;for metastasis of bone, the efficacy in ameliorating pain was good,but the response rate was unsatisfactory ; for metastasis of liver there was no effect. Neutropenia was significantly different between PFL regimen and PF regimen (P<0.05). Ⅲ—Ⅳgrade of neutropenia and mucositis and alepecia were very significantly different between PFL regimen and PF regimen (P<0.01). There was no significant difference in nausea, vomitng et al. Conclusions:These data show PFL regimen to be an effective method of treatment in advanced NPC.