含紫杉醇化疗联合体外放射治疗中晚期鼻咽癌的临床研究  

Time and sequential chemotherapy combined with radiotherapy in treatment of advanced nasopharyngeal carcinoma

作　　者：姜武忠[1] 张琳[1] 廖遇平[1] 张静[1] 王云龙[1] 

机构地区：[1]中南大学湘雅医院肿瘤科,长沙410008

出　　处：《上海医学》2006年第11期763-765,共3页Shanghai Medical Journal

基　　金：湖南省自然科学基金(03jjy3058)

摘　　要：目的观察紫杉醇+顺铂(PD)方案化疗联合体外放射治疗对晚期鼻咽癌的疗效。方法150例Ⅲ～Ⅳa期中晚期鼻咽癌患者均衡设计随机均分为3组。对照组单纯常规分割放射治疗；序贯组常规分割放射治疗后予PD方案化疗3～4个周期；交替组予PD方案化疗1个周期后常规分割放射治疗,在放射治疗中再单药紫杉醇化疗1～2个周期,放射治疗结束后再予PD方案化疗3个周期。PD方案：紫杉醇135mg/m^2静脉滴注,持续4h,第1天给药；顺铂80mg/m^2静脉滴注,分3d给药,21d为1个周期。照射用6mV X线,每次肿瘤量2Gy,7～8周,原发灶肿瘤照射剂量(DT)70～80Gy,颈部预防照射D_T 50～56 Gy,颈部转移灶D_T 65～70Gy。结果交替组完全缓解率(98%)和3年生存率(84%)均明显高于序贯组(86%和68%)和对照组(82%和56%,P值均＜0．05)。交替组和序贯组的远处转移率分别为6%和8%,明显低于对照组的22%(P值均＜0．05)。结论PD方案化疗和放射治疗交替可促进局部肿块的消退,提高远期疗效；PD方案可作为晚期鼻咽癌的首选化疗方案。Objective To evaluate the efficacy of radiotherapy combined with chemotherapy for advanccd nasopharyngeal carcinoma. Methods We randomly divided 150 patients with Ⅲ-Ⅳa stage of nasopharyngeal carcinoma （NPC） into three groups according to the timing and sequential chemotherapy combined with radiotherapy. ① Control group （n = 50） ： conventional radiotherapy only. ② Sequential group （n = 50） ： Conventional radiotherapy was given first and followed by four courses of chemotherapy. ③Alternating group（n = 50） ： radiotherapy was given after the first cycle of chemotherapy and followed by three cycles of chemotherapy. Chemotherapy regimen （PD） ： contained （135 mg/m^2 , iv） paclitaxel and DDP（80 mg/m^2 , d1-3）. The primary tumor received a total dose of 70-80 Gy with 2 Gy perday by 6 MV X ray. Patients with cervical lymph node metastasis received 65-70 Gy over the neck whereas patients with no cervical lymph node metastasis received only a prophylactic radiation of 50-56 Gy. Results Among the three groups complete remission rate of primary lesion of nasopharynx was the alternating group, showing a significant statistical difference（P 〈 0.05）. Three-year survival rate was also higher in the alternating group than those of the other two groups（P 〈 0.05）. The distant metastasis rates were significantly lower in the sequential group and alternating group than that in the control group （P〈0.05）. Conclusions PD chemotherapy regimen can accelerate primary tumor remission, improve the survival rate and lower the metastastic potentiality in patients with advanced nasopharyngeal carcinoma and should be the first, choice

关 键 词：鼻咽肿瘤 药物疗法 放射疗法 综合治疗 

分 类 号：R739.63[医药卫生—肿瘤]