放化疗顺序对鼻咽癌治疗效果的差异研究

Study on the effect of radiotherapy and chemotherapy sequence in the treatment of nasopharyngeal carcinoma

目的探究放化疗顺序对鼻咽癌治疗效果的差异。方法收集经临床影像学检查及病理检查确诊的鼻咽癌患者129例,根据治疗方案不同将患者分为诱导组(n=65)和同期组(n=64),其中诱导组采用顺铂+5-氟尿嘧啶(5-Fu)诱导化疗加调强放疗治疗,同期组采用顺铂同期放化疗治疗。对两组患者的疗效、不良反应发生情况及生存情况进行比较。结果诱导组与同期组患者治疗的总有效率比较,差异无统计学意义(P﹥0.05);同期组患者的胃肠道反应及白细胞下降发生率均明显高于诱导组。两组患者的随访时间为6~97个月,中位随访时间40个月,诱导组患者的中位生存时间为45个月(95%CI:39.228~50.772),同期组患者的中位生存时间为43个月(95%CI:35.159~50.841),两组患者的生存情况比较,差异无统计学意义(χ2=0.796,P﹥0.05)。结论诱导化疗加调强放疗治疗局部晚期鼻咽癌的疗效与同期放化疗相近,但同期放化疗不良反应较重。

Objective To explore the influence of the sequence of radiotherapy and chemotherapy in the treatment of nasopharyngeal carcinoma. Method 129 patients with pathologically confirmed nasopharyngeal carcinoma were stratified as induction therapy group（n=65） or concurrent therapy group（n=64）, for which the cisplatin＋5-Fu induced chemotherapy and concurrent cisplatin radiochemotherapy were administered, respectively. The efficacy, adverse reactions and survival in the two groups were compared. Result The induction therapy group and the concurrent therapy group were similar in respect of overall response（P〉0.05）; the incidence of gastrointestinal reactions and decreased WBC count was higher in concurrent therapy group compared to induction therapy group. The patients in the two groups were followed up for 6 to 97 months, with a median follow-up period of 40 months, and the median survival time was 45 months（95%CI：39.228-50.772） in induction therapy group, and was 43 months（95%CI： 35.159-50.841） in concurrent therapy group, no significant difference was observed in regard of the survival between the two groups（χ2=0.796, P〉0.05）. Conclusion The effect of induction chemotherapy combined with intensity modulated radiotherapy is similar with that of concurrent radiochemotherapy for locally advanced nasopharyngeal carcinoma, and the adverse reactions are usually more severe in concurrent radiochemotherapy.