放射治疗加化疗治疗晚期鼻咽癌的临床研究

TIME AND SEQUENCE OF CHEMOTHERAPY AND RADIOTHERAPY IN THE TREATMENT OF ADVANCED NASOPHARYNGEAL CARCINOMA

目的 :观察放化综合治疗晚期鼻咽癌的疗效。方法 :15 0例Ⅲ～Ⅳa期晚期鼻咽癌随机均衡设计分为 3组。对照组 5 0例 :单纯常规分割放射治疗 ;序贯组 5 0例 :先常规分割放射治疗后化疗 4疗程 ;交替组 5 0例 :先化疗 1疗程后 ,常规分割放射治疗 ,再化疗 3疗程。化疗方案用顺铂 (DDP) +5 -氟脲嘧啶 (5 -Fu) +亚叶酸钙 (CF) (CDF方案 ) ,DDP4 0mg/d ,1～ 3d :5 -Fu 0 .75 /d ,1～ 5d ;CF 0 .2 /d ,1～ 5d ;每 3～ 4周 1疗程。照射用6MV -X线 ,每次肿瘤量 2Gy ,7～ 8周 ,原发灶DT70～ 80Gy ,颈部预防照射DT5 0～ 5 6Gy ,颈部转移灶DT6 5～70Gy。结果 :交替组完全缓解率高于序贯组与对照组 (P <0 .0 5 ) ,有统计学意义。 3年存活率交替组高于对照组与序贯组 (P <0 .0 5 ) ,有显著性差异。结论 :CDF方案化疗与放疗交替可促进局部肿块的消退 ,提高远期疗效 ,CDF方案可作为晚期鼻咽癌的首选化疗方案。

Objective:To evaluate the result of radiotherapy combined with chemotherapy for advanccd nasopharyngeal carcinoma.Methods:We randomly divided 150 patients with Ⅲ-Ⅳa Stage of nasopharyngeal carcinoma(NPC) into three groups according to the timing and sequencing of chemotherapy and radiotherapy:(1)control group(50 patients): only conventional radiotherapy was given. (2) Sequential group (50 patients): conventional radiotherapy was given first and followed by four courses of chemotherapy. (3) Alternating group (50patients): radiotherapy was given after the first cycle of chemotherapy and followed by three cycles of chemotherapy. Chemotherapy regimen(CDF): DDP iv 40mg/d d1～3, 5-Fu 0.75/d iv d1～5, CF 0.2/d iv d1～5. The primary tumor received a total dose 70～80Gy with 2Gy per day by 6MV-x ray. Patients who had cervical lymph node metastasis received 65～70Gy to the neck whereas patients who did not have cervical lymph node metastasis received a prophylactic radiotion of 50～56Gy.Results:The complete remission rate of primary lesion of the nasopharynx was group sequencitg group, with a difference among the three groups statistically significant ( P <0.05). Three-year survival rate was higher in alternating group than in the other two groups( P <0.05).Conclusions:These results suggest that the CDF chemotherapy regimen can accelerate primary tumor remission, improve the survival rate in patients with advanced nasopharyngeal carcinoma. It is the first choice in combined treatment for avanced nasopharyngeal carcinoma.