鼻咽癌增量时间调节化疗加后程三维适形放射治疗的临床研究

Incremental chrono-chemotherapy plus late course three-dimensional conformal radiotherapy and incremental conventional chemotherapy plus radiotherapy for nasopharyngeal carcinoma

目的 探讨顺铂＋5-氟尿嘧啶/亚叶酸钙（DDP＋5-FU/CF）增量时间调节化疗加后程三维适形放疗治疗鼻咽癌的疗效。方法 2006年3月至2007年10月收治60例鼻咽癌患者，按信封法随机分为两组：增量时间调节化疗加后程三维适形放疗（3D-CRT）组（时辰组）和常规放化疗组（常规组），每组30例。所有病例均先采用两周期诱导化疗后行单纯放疗。两组化疗方案及用药剂量相同，DDP总量100 mg/m2，5-FU 1 g/m2·d，连用3 d，14 d为1个周期，共2个周期。两组化疗后均用直线加速器给予鼻咽部相同的放疗剂量DT70 Gy/7周，2 Gy/次，5次/周。鼻咽部应用面颈联合野常规放疗DT 36 Gy/4周后，常规组缩野改为常规耳前野放疗DT 34 Gy/3~4周，时辰组改为后程三维适形放疗DT34 Gy/3~4周。结果 时辰组完全缓解率（CR）及有效率（CR＋PR）分别为50%和100%，高于常规组的23.3%和93.3%，其中CR的差异有统计学意义（χ2 =4.593，P〈0.05）。1、 3、 5年总生存率及无疾病生存率两组的差异无统计学意义。相对于常规组，时辰组化疗的骨髓及消化道不良反应减低（χ2=4.285、4.344，P〈0.05）。结论 DDP＋5-FU/CF增量时间调节化疗加后程三维适形放疗较常规放化疗能减轻骨髓及消化道的不良反应，提高鼻咽癌的完全缓解率，但未降低远期生存率。

Objective To compare the therapeutic effects, side effects, and long-term survival between incremental chrono-chemotherapy with Dichlorodiammineplatinum （DDP）＋5-Fluorouracil （5-FU）/Calcium Folinate （CF） plus late course three-dimensional conformal radiotherapy （3D-CRT） and incremental conventional chemotherapy plus radiotherapy in treatment of nasopharyngeal carcinoma （NPC）. Methods Sixty NPC patients were divided randomly by envelope method into 2 equal groups： chrono-chemotherapy group treated by incremental chrono-chemotherapy plus late course three-dimensional conformal radiotherapy, and conventional chemotherapy group treated by incremental routine chemotherapy plus radiotherapy. All patients underwent 2 cycles of induction chemotherapy followed by single radiotherapy. The regimen and dosages of chemotherapy were the same with DDP at the total dosage of 100 mg/m2 for 3 d,14 d in a circle and 2 circles in total. After the induction chemotherapy, all patients received radiotherapy with the total dose DT of 70 Gy for 7 weeks, 2 Gy/fraction, 5 fractions/week. The nasopharynx received conventional radiotherapy of DT 36 Gy/4 weeks. Then the supplemental dose of 34 Gy/3-4 weeks was delivered by using conventional method in conventional chemotherapy group and late-course 3D-CRT in the chrono-chemotherapy group.Results The complete response （CR） rate of the chrono-chemotherapy group was 50%, significantly higher than that of the conventional chemotherapy group （χ2 =4.593, P〈0.05 ）. There were not significant differences between 2 groups in the effective response （CR＋PR） rate, 1-, 3-, and 5-year overall survival rates, and disease free survival rate. The incidence rates of gastrointestinal adverse reactions and bone marrow suppression of the chrono-chemotherapy group were significantly lower than those of the conventional group （χ2=4.285,4.344,P〈0.05）.Conclusions Compared with the incremental routine-chemotherapy-radiotherapy, incremental chrono-chemotherapy （DDP＋5-FU/CF） plus late course 3D-CRT may be more favorable in the treatment of NPC with less side-effects and without reducing the long-term survival of patients.