诱导性动脉内灌注化学治疗在晚期鼻咽癌治疗中的价值

Value of regional intra-arterial induction chemotherapy for locally advanced nasopharyngeal carcinoma

目的 明确诱导性区域动脉灌注化学治疗在局部晚期鼻咽癌 (nasopharyngealcarcinoma,NPC)治疗中的价值。方法 采用前瞻性随机对照研究 ,将病理确诊的 12 1例晚期 (III～IV期 )初治NPC患者于放射治疗前随机分成两组 ,6 1例进行区域性动脉灌注化学治疗 (intra arterialchemotherapy,IACT) ,6 0例采用全身化学治疗 (systemicchemotherapy ,SCT) ,对比化学治疗完全缓解率及毒副反应发生情况 ,放射治疗后比较两组的疗效。统计学处理采用卡方检验。结果 IACT组化学治疗的全身性毒副反应发生率较SCT组低 ,口腔炎的发生率较高 (P值分别为 <0 0 5或 <0 0 0 5 )。IACT组有 6例因血管闭塞不能进行第 2疗程的化学治疗。IACT组化学治疗完全缓解率及 5年生存率分别为 2 7 9%(17/ 6 1)和 6 3 9%(39/ 6 1) ,而SCT组分别为 11 7%(7/ 6 0 )和 45 0 %(2 7/ 6 0 ) ,两组相比较均有统计学差异 (P值均 <0 0 5 ) ;两组间无瘤生存率比较 ,差异无显著性 (P >0 0 5 )。结论 以IACT行诱导化学治疗对III～IV期局部晚期NPC更为合理。

Objective To define the value of regional intra-arterial induction chemotherapy for locally advanced nasopharyngeal carcinoma (NPC). Methods 121 locally advanced NPC(stage III～IV) patients confirmed by pathology were randomly divided into two groups before radiation, and the two groups were given two different methods of chemotherapy: regional intra-arterial chemotherapy (IACT) and systemic chemotherapy (SCT). After radiation the effect of two methods was compared. Results The complete response rates were 27.9% in the IACT and 11.7% in the SCT , and 5 years survival rates were 63.9% in the IACT and 45.0% in the SCT respectively. The differences of two groups were significant. Conclusion IACT is more reasonable than SCT as induction chemotherapy for these locally advanced NPC.