诱导化疗加放射治疗Ⅳ期鼻咽癌的疗效观察

Induction chemotherapy and radiotherapy in the treatment of patients with Ⅳ(N_3M_0) stage nasopharyngeal carcinoma

目的 :评价诱导化疗加放射治疗和单纯放疗治疗Ⅳ (N3 M0 )期鼻咽癌的临床疗效。方法 :将经病理证实的 3 4例Ⅳ (N3 M0 )期鼻咽癌 3 4例随机分为诱导化疗加放疗组 (Ⅰ )和单纯放疗组 (Ⅱ )。Ⅰ组放疗前应用PF方案(DDP+5 -FU)化疗 2周期 ,2组放疗方法相同。结果 :Ⅰ组和Ⅱ组鼻咽部肿瘤完全消退率分别为88.2 %和 82 .4% ,颈部转移淋巴结完全消退率分别为 94.1 %和 88.2 % ,差异无显著性 (P >0 .0 5 ) ;Ⅰ组和Ⅱ组 3年生存率分别为 70 .6%和 47.1 % ,差异有显著性 (P <0 .0 5 ) ;Ⅰ组和Ⅱ组远处转移率分别为 2 3 .5 %和41 .2 % ,差异有显著性 (P <0 0 5 )。Ⅰ组治疗毒副反应比Ⅱ组重。结论 :诱导化疗加放射治疗Ⅳ (N3 M0 )期鼻咽癌 ,可以提高 3年生存率 ,减少远处转移率 ,毒副反应比单纯放疗大 ,但不影响治疗进程。

Objective:To compare the effect of induction chemotherapy plus radiotherapy and radiotherapy alone for nasopharyngeal carcinoma (NPC). Method:34 patients with histological proved Ⅳ(N 3M 0) stage NPC were randomized into two groups:Group Ⅰ(17 cases) was treated with 2 cycles of induction chemotherapy (DDP and 5-Fu)followed by radiotherapy;Group Ⅱ(17 cases) was treated with the same radiotherapy alone.Result:The complete response rates in group Ⅰ and group Ⅱ were 88.2% and 82.4% respectively with no significant difference ( P>0.05 ).The 3-year survival rates were 70.6% and 47.1%( P<0.05) .The 3-year distant metastasis rates were 23.5% and 41.7% respectively ( P<0.05 ).The toxicities of group Ⅰ was more serious than group Ⅱ,but no death and delay of programs occurred.Conclusion:Induction chemotherapy plus radiotherapy may increase the local disease control and 3-year survival rate and decrease the distant metastasis rate in patients with Ⅳ (N 3M 0) stage NPC.