NP及FP方案诱导化疗同步适形调强放疗治疗局部晚期鼻咽癌

Induction chemotherapy plus concurrent chemoradiotherapy （IMRT） in the treatment of locally advanced nasopharyngeal carcinoma

目的：评价NP及FP方案诱导化疗＋同步适形调强放疗治疗局部晚期鼻咽癌的毒副作用和疗效。方法经病理学或细胞学证实的局部晚期鼻咽癌患者81例，采用数字表法随机分为两组。观察组采用NP方案诱导化疗：长春瑞滨（NVB）25～30 mg/m2，第1、8天；顺铂（DDP）75 mg/m2，分为第1～3天。对照组：PF方案诱导化疗，DDP 75 mg/m2，分为第1～3天；氟尿嘧啶（ Fu）750 mg/m2第1～5天，均每3周重复，化疗2～4周期，化疗结束后进行同步放化疗。观察组同步化疗：NVB 25～30 mg/m2，DDP 40 mg第1、8、22、29、43、51天，对照组同步化疗：Fu 750 mg/m2，DDP 25/m2第1、8、22、29、43、51天。同时给予同步鼻咽＋颈部适形调强放疗。结果随访率为100％，观察组与对照组Ⅲ～Ⅳ度血液学毒性累计：白细胞减少47．5％与24.4％（χ2＝4．73，P＜0．05）。Ⅲ～Ⅳ度急性黏膜反应10％与20％。5年无局部区域复发生存率85．0％与65．9％（χ2＝4．05，P＜0．05）。5年总生存85．0％与68．3％（χ2＝3．18，P＜0．05）。结论 NP较FP方案诱导化疗＋同步适形调强放疗治疗局部晚期鼻咽癌局部控制率高，5年无复发生存率高，毒副作用可耐受，远期毒性低。

Objective To investigate the efficacy and side effect of induction chemotherapy plus concurrent chemoradiotherapy （ IMRT） in the treatment of 81 patients with locally advanced nasopharyngeal carcinoma （ NPC） . Methods 81 patients with locally advanced NPC were divided into the vinorelbine group and fluorouracil group . Patients in the vinorelbine group were given vinorelbine 25-30mg/m2 d1,d8,DDP 75mg/m2 ,d1-d3.Patients in the fluorouracil group were given DDP 75mg/m2,d1-d3,fluorouracil 750 mg/m2 d1-d5.The treatment schedules were recycled every 3 weeks.After 2-4 cycles, the patients received concurrent chemoradiotherapy .In the vinorelbine group,IMRT with NVB 25-30mg/m2,DDP 40mg d1,d8,d22,d29,d43,d51 from the first day of IMRT.In the fluorou-racil group,IMRT with fluorouracil 750mg/m2 ,DDP 25/m2 d1,d8,d22,d29,d43,d51 from the first day of IMRT. Results The overall leukopenia and thrombocytopenia decline was 47.5% vs 24.4% in patients with Ⅲ and Ⅳgrade（χ2 =4.73,P〈0.05）.5-year locoregional relapse-free survival rates were 85.0% vs 65.9%（χ2 =4.05,P〈0.05）.5-year overall survival rates were 85.0%vs 68.3%（χ2 =3.18,P〈0.05）.Conclusion NP regiment induc-tion chemotherapy plus concurrent chemoradiotherapy for advanced NPC can achieve better result in clinical response and 5-year locoregional relapse-free survival rate compared with FP and the effect is clinically acceptable .