交替化疗方案加放疗治疗局部晚期鼻咽癌临床观察

Clinical Observation on Alternating Chemotherapy plus Radiotherapy for Locally Advanced Nasopharyngeal Carcinoma

目的观察交替化疗方案加放疗治疗局部晚期鼻咽癌临床疗效、毒副反应。方法 128例初治Ⅲ、Ⅳa期鼻咽癌患者随机分为2组,每组64例,放化组:在放疗的第1天开始给予DDP+5-Fu化疗1周期,第29天给予CBDCA+BLM化疗1周期;单放组:给予单纯放疗。结果疗程结束时,鼻咽病灶消退率为95.31%,高于单放组的76.56%(P<0.01),颈部淋巴结转移灶消退率放化组为98.43%,高于单放组的87.50%(P<0.01);放化组1、3、5年生存率分别为96.88%、76.56%、54.69%,单放组为90.63%、45.31%、32.81%,两组比较差异有统计学意义(P<0.05)。早期毒副反应:恶心呕吐、口咽黏膜反应和白细胞减少发生率放化组较单放组高且重。远期并发症两组相似。结论交替化疗方案加放疗可提高局部晚期鼻咽癌的肿瘤消退率和5年生存率,早期毒副反应发生率高且重,但均能耐受。

Objective To observe the clinical effects and toxic reaction of alternating chemotherapy plus radiotherapy for locally advanced nasopharyngeal carcinoma. Methods One hundred and twenty-eight patients with nasopharyngeal carcinoma stage Ⅲ to Ⅳa were randomly allocated into two groups,with 64 cases in each group. The concurrent group received one cycle of concurrent chemotherapy with cisplatin plus fluorouracil on the first day of radiotherapy,and then received another cycle of concurrent chemotherapy with carboplatin plus bleomycin on the twenty-ninth day. The radiotherapy group received radiotherapy alone. Results At the end of treatment,the complete remission rate of the nasopharynx lesions in the concurrent group was significantly higher than that in the radiotherapy group（ 95. 31% vs. 76. 56%,P〈0. 01）,and the complete remission rate of the cervical metastatic lymph nodes in the concurrent group was higher than that in the radiotherapy group（ 98.43% vs. 87. 50%,P〈0. 01）. The 1-,3-,5-year survival rates were 96. 88%,76. 56%,54. 69% in the concurrent group,respectively,and 90. 63%,45. 31%,32. 81% in the radiotherapy group,respectively,there were significant differences between two groups（ P〈0. 05）. The concurrent group had more and severer early toxic reactions such as nausea,vomiting,mucositis and leukopenia compared with radiotherapy group. But the two groups had similar long-term complications.Conclusion Alternating chemotherapy plus radiotherapy can improve the complete remission rate and 5-year survival rate of locally advanced nasopharyngeal carcinoma. It is tolerated,though it has more and severer early toxic reactions.