化放疗与单放疗治疗Ⅲ,Ⅳa期鼻咽癌远期疗效的比较  

Comparison of the long-term effects of chemo-radiotherapy and radiotherapy alone for patients with stage Ⅲ, Ⅳa nasopharyngeal carcinoma

作　　者：陆小军[1] 雷风[1] 吴新光[1] 叶亦菁[1] 刘玉猛[1] 何伟基[1] 周锡刚[1] 王得坤[1] 

机构地区：[1]中山市人民医院放疗科,广东中山528403

出　　处：《第四军医大学学报》2006年第24期2271-2273,共3页Journal of the Fourth Military Medical University

基　　金：广东省名医工程研究基金(200435)

摘　　要：目的:比较诱导化疗综合放疗与单纯放疗对局部晚期鼻咽癌远期生存的影响.方法:病理确诊的Ⅲ,Ⅳa期鼻咽癌180例随机均分为化放组和单放组,化放组用含Cisplatin为主的联合方案诱导化疗2个疗程后1wk内开始放疗,其中采用DFP,TFP方案化疗47例,采用PF,PFB,EFP方案化疗43例.两组采用的放射治疗技术基本一致.结果:化放组与单放组3,5a累积转移10,16例和25,31例;累积复发22,29例和26,32例;化放组无转移3,5a生存率(DMFS)为88.9%和82.2%;无复发生存率(RFS)为75.6%和67.8%;单放组3,5aDMFS为72.2%和65.6%;3,5aRFS为71.1%和64.4%.两组3,5aRFS无差异(P=0.089,P=0.076),而3,5aDMFS统计学有显著差异(P=0.029,P=0.024).诱导化疗以含紫杉醇类的联合方案(DFP,TFP)较经典的FP,FBP,EFP方案疗效为优(3,5年DMFS:P=0.019;P=0.022).但前组群Ⅲ,Ⅳ度急性口腔粘膜炎和白细胞下降明显高于后组群(51.1%vs30.2%,P=0.018;34.0%vs14.0%,P=0.07).在G-CSF等支持下不良反应尚可耐受,无治疗相关死亡、过敏、终止或需降低放化疗剂量的病例.无后期放疗需推迟进行的病例.结论:诱导化疗综合放疗组较单纯放疗组能明显降低局部晚期鼻咽癌的远处转移率.但两组RFS无差异.诱导化疗系列方案中DFP,TFP方案较经典的FP,FBP,EFP疗效为优,但Ⅲ,Ⅳ度不良反应前组群方案为重.AIM： To study and compare the long-term effects of chemo-radiotherapy and radiotherapy alone in the treatment of nasopharyngeal carcinoma （ NPC ）. METHODS ： A total of 180 patients with stage Ⅲ or Ⅳa NPC diagnosed pathologically were randomly divided into chemotherapy plus radiotherapy group （ CT/ RT group） and radiotherapy alone group （RT group）. Cisplatinbased induction chemotherapy was performed in CT/RT group for 2 cycle （DFP, TFP, in 47 cases; PF, PFB, EFP in 43 cases） and radiotherapy was started in 1 week after the last chemotherapy. The methods of radiation were the same in both groups. RESULTS： The distant metastasis free survival （DMFS） rates in 3 and 5 years were 88.9%, 82.2% and the relapse free survival （RFS） rates in 3 and 5 years were 75.6%, 67.8% in CT/RT group; the 3, 5-year DMFS rates were 72.2%, 65.6% and the 3, 5-year RFS rates were 71. 1%, 64.4% in RT group; there was no differences of statistical significance in 3, 5-year RFS rates （ P = 0. 089, P = 0. 076 ）, but there was statistically significant difference in 3, 5-year DMFS rates （ P = 0. 029, P = 0. 024 ）. The therapeutic effect of induction chemotherapy project including paclitaxel such as DFP, TFP was more excellent than classical chemotherapy projects such as FP, FBP, EFP （3, 5-year DMFS： P = 0. 019, P = 0. 022）. The acute oral mucositis of Ⅲ, Ⅳdegree and leucopenia in the former groups were much more severe than those in the latter groups （51. 1% vs 30. 2% , P = 0.018; 34. 0% vs 14. 0%, P = 0. 07）. But these adverse eactions can be tolerable by using G-CSF. There were no cases or death of allergy correlated to treatment. No patients need to decrease the dose of chemotherapy or radiation or to terminate the treatment, or to delay the late radiotherapy. CONCLUSION： The chemo-radiotherapy can decrease significantly the rate of distant metastasis as compared with radiotherapy alone, but there is no statistically significant difference in RFS rate. The therapeutic effect of inducti

关 键 词：鼻咽肿瘤/药物疗法 放射疗法 治疗结果 

分 类 号：R739.63[医药卫生—肿瘤]