诱导化疗和放疗综合治疗晚期鼻咽癌的前瞻性研究

A Prospective Randomized Study of Neoadjuvant Chemotherapy and Radiotherapy in Advanced Nasopharyngeal Carcinoma

目的 比较诱导化疗加放疗与单纯放疗治疗晚期鼻咽癌的疗效。方法 将 78例Ⅲ、Ⅳa期鼻咽癌随机分为 2组 ,每组 3 9例。治疗组 (A组 )诱导化疗 2个疗程后再行放疗 (化疗方案 :卡铂 3 0 0mg/m2 ,静脉滴注 ,第 1天 ;5 Fu 5 0 0mg/m2 ,静脉滴注 ,第 1～ 3天 ;平阳霉素 16mg/m2 ,静脉滴注 ,第 1天 ) ;对照组 (B组 )单纯放疗。结果 诱导化疗后鼻咽癌病灶及颈淋巴结有效率(CR +PR )分别为 5 3 .8% (2 1/3 9)、72 .7% (2 4/3 3 )。A、B组 5年总生存率及无瘤生存率分别为 43 .6%、40 .8% ,3 8.4%、3 4.0 % (P>0 .0 5 ) ;远处转移率A、B组分别为 3 8.5 %、41.0 % ;2组远期严重并发症发生率相近。结论 诱导化疗加放疗不能提高晚期鼻咽癌患者的生存率 ,也不能降低其远处转移率。

Objective To compare the theraputic effects of chemoradiotherapy plus radiotherapy and radiotherapy(RT) alone for advanced nasopharyngeal carcinoma(NPC).Methods 78 patients with Ⅲ Ⅳa NPC were randomized into two groups.39 patients received two courses of neoadjuvant chemotherapy before RT as study group(A) and 39 patients received RT alone as control group(B).The chemotherapy regimen consisted of carboplatin 300 mg/m 2 given in i.v.on Day 1,and 5 Fluorouracil(5 Fu) 500 mg/m 2 given in i.v.on Day 1,2,3,and pingyangmycin 16 mg/m 2 given in i.v.on Day1.Results The response rate to neoadjuvant chemotherepy was 53.8%(21/39) in local nasopharyngeal disease and 72.7%(24/33) in cervical lymph node.The 5 year survival rate was 43.6% in group A and 40.8% in group B.The 5 year Disease free survival rate was 38.4% in group A and 34.0% in group B( P >0.05).The distant relapse was 38.5% in group A and 41.0% in group B.The long term and serious complications were similar in both groups.Conclusion neoadjuvant chemotherapy plus radiotherapy in advanced NPC can't improve survival rate,disease free survival rate and decrease distant relapse rate.