80例Ⅲ、Ⅳ期鼻咽癌采用DFP与PFB方案同期化放疗的疗效比较  

The Comparison of Efficacy between Concurrent DFP and PFB Chemotherapy in Combination with Radiotherapy for 80 Patients with Nasopharyngeal Carcinoma of Stage Ⅲ or Ⅳ

作　　者：陆小军[1] 吴新光[1] 雷风[1] 刘玉猛[1] 叶亦菁[1] 郑斯明[1] 

机构地区：[1]中山市人民医院放疗科,广东省中山市528403

出　　处：《中国肿瘤临床》2005年第17期1008-1011,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:应用DFP方案(多西紫杉醇,5-氟脲嘧啶和顺铂)及PFB方案(5-氟脲嘧啶,顺铂和平阳霉素)与放疗同步治疗Ⅲ,Ⅳ期鼻咽癌,观察比较两组的局控率,生存率及不良反应。方法:对80例经过病理学证实且无远处转移的Ⅲ,Ⅳ期初治鼻咽癌患者给予同期化放疗,随机分为DFP组和PFB组,两组各40例。DFP组多西紫杉醇60mg·m·2d,静脉滴注,d1(或d1,d8),顺铂25mg·m·2d,静脉滴注,d2～5,5-氟脲嘧啶500mg·m·2d,静脉滴注,d2～5。PFB组顺铂25mg·m·2d,静脉滴注,d1～5,5-氟脲嘧啶500mg·m·2d,静脉滴注,d1～5,平阳霉素16mg,深部肌注,d1,3,5。两组均为21天一个周期,共2个周期。放疗采用60COγ线照射,常规分割,与化疗同期进行。肿瘤原发灶DT65～70Gy/6.5～7.5周,颈部转移淋巴结区DT55～66Gy/6～7周。颈部,锁骨上窝预防照射区DT50Gy/5周。结果:DFP组总有效率(CR+PR)为95.0%,1年无复发生存率为85.0%,1年无转移生存率为90.0%;PFB组总有效率(CR+PR)为85.0%,1年无复发生存率为80.0%,1年无转移生存率为70.0%。两组间有效率、1年无复发生存率比较差异无显著性,1年无转移生存率比较差异有统计学意义(P<0.05)。最常见的不良反应为恶心,呕吐,DFP组主要不良反应是急性口腔粘膜炎和白细胞下降(Ⅲ+Ⅳ度分别为50.0%和40.0%),但在G-CSF的支持下均可耐受。结论:DFP组和PFB组相比,近期疗效和1年无复发生存率相似,1年无转移生存率DFP组优于PFB组,但Ⅲ～Ⅳ度不良反应较PFB组为重,应有切实的措施减轻不良反应。Objective： To compare the rates of local control, survival and toxicity of concurrent DFP （DOC, DDP plus 5-FU） versus PFB （DDP, 5-FU plus BLM） chemotherapy in combination with radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Methods： A total of 80 patients with stage-Ⅲ or stage-Ⅳ nasopharyngeal carcinoma diagnosed pathologically, without distance metastasis, were randomly divided into two groups. The DFP chemotherapy regiment was administered as follows： docetaxel 60mg/m^2/d, i.v. infusion on day 1 （or day 1, days 8）, cisplatin 25 mg/m^2/d, on day 2 to 5, 5-Fu 500 mg/m^2/d, on day 2 to 5. The PFB chemotherapy regiment was as follows： cisplatin 25 mg/m^2/d, on day 2 to 5, 5-Fu 500 mg/m^2/d, on day 2 to 5, pinyangmycin 16 mg, i.m, on day 1, 3 and 5. Each chemotherapy regiment was administered for 2 cycles, with 21 days each cycle. Radiotherapy was used by cobah-60, with simultaneous chemotherapy. The patients were treated by conventional fraction. The accumulated radiation dose was 65 to 70Gy/6.5 to 7.5 weeks for primary tumor, 55 to 66Gy/6 to 7 weeks for the involved area of the neck was and 50Gy/5 weeks for the uninvolved area. Results： The overall response rate （complete response and part response） was 95.0% and 85.0% in DPF group and PFB group, respectively. The 1-year free from local regional failure survival rate （FLF） was 85.0% and 80.0% and the 1-year free-distant metastasis survival rate （FDM） was 90.0% and 70.0%. The difference of overall response rate and the 1-year FLF between the two groups were not statistically significant. The difference of 1-year FDM was statistically significant （P〈0.05）. The adverse effects were nause and vomiting. The main toxicity were acute inflammation of oral mucosa and leucopenia （grade Ⅲ or Ⅳ was 50.0% or 40.0%） in the DPF group. The difference between the two groups was statistically significant. But these can be tolerable by using G-CSF. Conclusion： The short efficacy and the 1-year FLF betw

关 键 词：鼻咽癌 多西紫杉醇 顺铂 5-氟脲嘧啶 同期化放疗 DFP方案 Ⅳ期鼻咽癌 PFB 疗效比较 无复发生存率 

分 类 号：R739.63[医药卫生—肿瘤]