鼻咽癌综合治疗的临床研究

Clinical study of combination treatment for nasopharygeal carcinoma

目的 :探讨一种适合对鼻咽癌进行综合治疗的方法。方法 :对 15 3例鼻咽癌随机分组研究 ;单纯放疗组 (甲组 )5 2例、放疗前诱导化疗组 (乙组 ) 5 2例、放疗同步化疗组 (丙组 ) 4 9例 ,各组均采用 6 0 Coγ射线或 4MVX线常规分割放疗 ,颈部加 180 KVX射线。鼻咽部剂量 70～ 80 Gy/ 7～ 8W,颈部预防照射 5 0 Gy/ 5 W,根治量 6 0～ 75 Gy/ 6～ 7.5 W。乙组在放疗前予 DDP5 0 m g,第 1,5天 ,5 - Fu5 0 0 mg,第 1～ 5天 ,静滴 ,休息 2周 ,再重复上述方案。丙组在放疗开始同时给予 DDP2 0 mg,第 1～ 5天 ,5 - Fu 5 0 0 m g,第 1～ 5天 ,静滴 ,第 4周再重复上述方案。结果 :甲、乙、丙组鼻咽部肿瘤完全消退率为 90 .4%、75 .0 %、 89.8%。颈部转移灶除 N0 者外 ,全消率分别为 75 .7%、 6 4.5 %、 75 .0 %。按临床分期比较消退率 、 、 a期 ,甲组分别为 85 .7%、 71.4%、 6 0 % ,乙组分别为 70 %、 5 8.3%、 6 6 .6 % ,丙组分别为 81.3%、 72 .7%、 6 3.4%。但经统计学处理 ,均无显著性差异 (P >0 .0 5 )。结论 :鼻咽癌综合治疗与单纯放疗疗效比较 ,晚期病例的近期疗效稍有提高 ,长期疗效有待进一步观察。

Objective:To study the methods of combination treatment nasopharygeal carcinoma.Methods: 153 patients with nasopharygeal carcinoma were randomly divided into three groups.49 patients radiotherapy(RT) alone(group A).52 patients received induction chemotherapy before RT with DDP (50mg,d1,5),5 Fu(500mg,d1~5) for 2 cycles(group B).52 patients received chemotherapy with DDP (20mg,d1~5),5 Fu(500mg,d1~5)in first and fourth week of RT(group C).RT in three groups was similar,patients in convention factionation received 2Gy/per fraction,five fraction/per week,with the total dose of 70~80Gy/7~8 week to nasopharynx,60~75Gy/6~7.5 week to lymph nose node involvement and 50Gy in regionally lymphatic drainage.Results: Nasopharynx complete remission rate of group A,group B and group C were 90.4%,75.0% and 89.8% respectively(P>0.05).Cervical node complete remission rate of group A,group B and group C were 75.7%,64.5% and 75.0%,respectively (P>0.05).At Ⅱ stage,CR rate of group A,group B and group C were 85.7%,70% and 81.3%,respectively (P>0.05).At Ⅲstage,CR rate of group A,group B and group C were 71.4%,58.3% and 72.7%,respectively (P>0.05).At Ⅳ-a stage,CR rate of group A,group B and group C were 60%,66.6% and 63.4%,respectively (P>0.05).Conclusions:The near term results of combination treatment for advanced nasopharygeal carcinoma is better than radiotherapy alone.The long term survival remains to be answered.=