调强放疗联合诱导化疗对比同期化疗治疗局部晚期鼻咽癌前瞻性研究的初期报告

Intensity-modulated radiotherapy pins induction chemotherapy versus concurrent chemotherapy in locally advanced nasopharyngeal carcinoma： the preliminary result of a prospective study

目的探索局部晚期鼻咽癌患者疗效确切、安全低毒、适合现代放疗的综合治疗方案。方法将88例病理确诊为世界卫生组织（WHO）Ⅱ、Ⅲ型鼻咽癌的Ⅲ~ⅣB期患者，按随机数字表法分为诱导化疗联合单纯放疗组（诱导组）（43例）和同期放化疗组（同期组）（45例），采用调强放疗（IMRT）技术给予根治量放疗。两组化疗方案均为1个疗程多西他赛联合顺铂（TP方案），1个疗程单药顺铂（DDP）。结果诱导组与同期组相比，2~4度白细胞下降发生率低[67.4%（29/43）比86.7%（39/45），χ2= 4.628，P=0.031]，其余急性不良反应差异均无统计学意义（均P〉0.05）。诱导组与同期组患者的近期疗效（95.3%比100.0%，P=0.236）、2年预期无进展生存率（94.6%比88.6%，P=0.303）、总生存率（95.5%比94.2%，P=0.627）、无局部复发生存率（97.3%比95.5%，P=0.951）、无区域复发生存率（94.7%比96.2%，P=0.949）及无远处转移生存率（93.7%比91.5%，P=0.454），差异均无统计学意义。结论局部晚期鼻咽癌患者接受TP/DDP诱导化疗联合单纯IMRT的疗效与同期放化疗无差别，且急性血液学不良反应发生率较低，值得进一步研究。

ObjectiveTo explore a desirable therapeutic regimen, which is effective, reasonable and practicable for locally advanced nasopharyngeal cancer （LA-NPC） patients in the era of IMRT, with a potential of translating into survival improvement of these patients. MethodsPatients presented with stage Ⅲ-ⅣB, WHO type Ⅱ or Ⅲ NPC were randomly assigned to receive concurrent chemoradiotherapy （CCRT group） （45 cases） or induction chemotherapy plus radiotherapy alone （IC＋ RT group） （43 cases）, with random number table. IMRT and rapid arc planning were generated in the same treatment planning system for all patients. These two arms received docetaxel plus cisplatin for first cycle of chemotherapy, and cisplatin only for the second cycle. ResultsForty-five patients received CCRT and 43 received IC＋ RT. All the patients completed two cycles chemotherapy. Compared to the CCRT group, the incidence rate of grade 2-4 leukopenia was lower in IC ＋ RT group[67.4% （29/43） vs. 86.7% （39/45）, χ2= 4.628, P= 0.031], while the incidence rate of dermatitis, mucositis, neutropenia and fungal infection of oral cavity had no significant differences （all P 〉 0.05）. The tumor response rate （95.3% vs. 100.0%, P= 0.236）, 2-year overall survival rate （95.5% vs. 94.2%, P= 0.627）, 2-year progression free survival rate （94.6% vs. 88.6%, P= 0.303）, 2-year local recurrent free survival rate （97.3% vs. 95.5%, P= 0.951）, 2-year regional recurrent free survival rate （94.7% vs. 96.2%, P= 0.949）, and 2-years distant metastasis free survival rate （93.7% vs. 91.5%, P= 0.454） of the two groups were similar while comparing CCRT to IC＋ RT group. ConclusionCombined IMRT with TP/DDP regimen, the efficacy of IC＋ RT is similar to CCRT for LA-NPC. The IC＋ RT group has less severe leukopenia than CCRT group, which is worth further study.