两种不同给药途径的大剂量醛氢叶酸联合5-氟尿嘧啶、顺铂治疗晚期鼻咽癌

Concomitant Cisplatin and 5- Fluorouracil with Veinal or with Oral High- Dose Leucovorin in Treatment of Patients with Advanced Nasopharygeal Carcinoma

目的：对比观察静脉及口服大剂量醛氢叶酸（ HDCF）、 5-氟尿嘧啶（ 5- FU）、顺铂（ DDP）联合化疗对晚期鼻咽癌的临床疗效及安全性。方法： 1997年 1月至 1999年 12月间， 53例经病理证实的晚期鼻咽癌患者，非随机分为 PFL1组 28例（按静脉 HDCF/5- FU＋ DDP方案化疗）， PFL2组 25例（按口服 HDCF/5- FU＋ DDP方案化疗）。结果： PFL1组完全缓解 (CR)率、有效率分别为 17.9％、 64.3％；所有病人随访至 1999年 12月止，已死亡 13人，尚存 15人，中位缓解时间 10.5月± 5.24月（ 5～ 21月），中位生存时间 12.5月± 5.13月（ 4～ 35月）。 PFL2组其 CR率、有效率分别为 16％、 56％。，已死亡 14人，尚存 11人，中位缓解时间 9.3月± 3.10月（ 4～ 28月），中位生存时间 11.2月± 3.66月（ 4～ 28月）。两组 CR率、有效率、中位缓解时间、中位生存时间均无显著性差异（ P >0.05）。 PFL1及 PFL2方案化疗均对鼻咽肿物、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。两方案的主要毒性反应均为白细胞下降、恶心、呕吐、口腔炎等，其毒性反应相似（ P >0.05）， PFL1组静脉炎（ P< 0.05）、脱发、色素沉着更多见（ P< 0.01）。结论：静脉及口服

Objective： The aim of this study was to assess the efficacy and safety of veinal high dose Leucovorin＋ 5- FU and cisplatin regimen（ PFL1） and oral high dose Leucovorin＋ 5- FU and cisplatin regimen（ PFL2） in the treatment of the patients with reccurent nasopharyngeal carcinoma. Methods: From January 1997 to December 1999,53 cases of histologically proven advanced nasopharyngeal carcinoma were unrandomly divided into 2 groups, of whom 28 cases were treated with PFL1 regimen, 25 cases with PFL2 regimen. Results: Complete response rate and respose rates of PFL1 regimen and PFL2 regimen were 17.9％ , 64.3％ ,and 16％ , 56％ ,respectively. All the patients had been followed- up till December 1999. Thirteen patients died and fifteen patients survived and median remission duration was 10.5± 5.24 months(range,5－ 21 months) and median survival duration was 12.5± 5.13 months(4－ 35 month) of PFL1 group. Fourteen patients died and eleven survived and median remission duration was (9.3± 3.10) m (4－ 28 m) and median survival duration was(11.2± 3.66) m (4－ 28 m) of PFL2 group. There was no significant difference in complete response rate, respose rate, median remission duration and median survival duration between the two groups (P >0.05). PFL1 and PFL2 chemotherapy regimens for nasopharyngeal mass, metastasis of neck or abdomen lymphnode, metastasis of lung were effective; for metastasis of bone, the efficacy of releasing pain was good, but the response rate was unsatistactory; for metastasis of liver had no effect. The major toxicity included neucopenia， nausea， vomiting， mucositis et al.（ P >0.05） . Vein inflammation had significant differences between two regimens (P< 0.05). Alepecia and pigmentation had very significant differences between two regimens (P< 0.01). Conclusions: Veinal or oral high dose Leucovorin＋ 5- Fu＋ cisplatin were effective combinnation in the chemotherapy of nasopharyngeal carcinoma and the survival duration were longer.