联合放化疗治疗晚期鼻咽癌的临床研究

Radiotherapy Combined with Chemotherapy in the Treatment of Patients with Advanced Nasopharyngeal Carcinoma

［目的］比较放、化疗与单纯放射治疗鼻咽癌的生存率、局部控制率、远处转移发生率和毒副反应。［方法］从 １９９１年 ４ 月至 １９９３年 １０月， １２６例Ｎ２、Ｎ３期鼻咽癌患者随机分入放、化疗组和常规放疗组。放、化疗组放疗前、中及（或）放疗后各用 ＰＤＤ＋ ５－Ｆｕ化疗一个疗程，化疗方案为 ＰＤＤ２０ｍｇ／ｍ２， １至 ５天；５－Ｆｕ５００ｍｇ／ｍ２１至 ５天；两组放疗方法相同，全部病例用 ８ＭＶ光子线及６０ＣＯ 外照射，鼻咽部剂量６５Ｇｙ－７０Ｇｙ／６．５周－７周。颈淋巴结转移灶剂量６５Ｇｙ－７０Ｇｙ／６．５周－７周，颈淋巴结预防剂量５０Ｇｙ／５周。 ［结果］放、化疗组和单放组鼻咽肿瘤完全消退率分别为９３．６ ％和８５．７％（Ｐ＞０．０５），颈部转移淋巴结完全消退率分别为８４．１％ 和５７．１％（Ｐ＜０．０５）；两组３年生存率分别为６８．３％和５２．４％（Ｐ＞０．０５）；Ｎ２期鼻咽癌患者３年生存率分别为７５．５％和５８．７％ （Ｐ＞０．０５），Ｎ３期鼻咽癌患者３年生存率分别为５０． ０％和３５．３％（Ｐ＞０．０５）；３年鼻咽部肿瘤控制率两组分别为对４％和５７．１％ （Ｐ＜０．０５），颈转移淋巴结控制率分别为６９．８％和５２．３?

Purpose] To compare the effect of radiotherapy combined with chemotherapy and radiotherapy alone in the treatment of nasopharyngeal carcinoma. [Methods] From April 1991 to October 1993, 126 patients with histologically proved nasopharyngeal carcinoma (stage N2. N3 ) were randomized into two groups: group A (63 cases) were treated with radiochemotherapy, receiving radiotherapy of (65 ~ 70) Gy/ (6. 5 ~ 7) W to the nasoparynx and (65 ~ 70) Gy/(6.5 ~ 7) W to neck and receiving 2 ~ 3 cycles of chemotherapy with PF protocol (5-Fu and cisplatin). Group B (63 cases) received the same radiotherapy alone. [Results]The complete response rates for the primary tumor in the group A and group B were 93. 6% and 85. 7% respectively with no significant difference (P > 0 .05) .The remission in the cervical lymph 'nodes was revealed to be better in group A than that in group B, their CR rates were 84. 1 % and 57. 1 % respectively with significant difference (P < 0.05) . The 3-year survival rates of group A and group B were 68.3% and 52.4% respectively (P > 0.05). The 3-year primary tumor and cervical node control rate in group A was higher than that in group B (P < 0.05) .The 3-year survival rate of N2 stage in group A and group B were 75 .5% and 58 .7% (P > 0 .05) .The 3-year survival rate of N3 stage in group A and group B were 50.0% and 35. 3% (P > 0.05) .The distant metastasis in group A was lower than that in group B (20. 6% vs 39 .7%, P> 0.05). [Conclusion] Radiotherapy combined with chemotherapy may in- crease local disease control and may diminish distant metastasis in patients with nasopharyngeal carcinoma.