局部晚期鼻咽癌同期放化疗及辅助化疗的临床研究  

Concurrent chemoradiotherapy followed by adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma

作　　者：付杰[1,2,3,4] 胡超苏[1,2] 

机构地区：[1]上海复旦大学附属肿瘤医院 [2]复旦大学肿瘤学系放疗科 [3]上海交通大学附属第六人民医院 [4]上海市第六人民医院放疗科

出　　处：《中国癌症杂志》2010年第5期369-374,共6页China Oncology

摘　　要：背景与目的:NCCN指南推荐晚期鼻咽癌应予以同期放化疗联合辅助化疗,本研究旨在评估改良同期放化疗及辅助化疗对局部晚期鼻咽癌患者的疗效、急性不良反应及其依从性情况。方法:2003年11月—2005年4月间,共收集67例Ⅲ、Ⅳ期局部晚期鼻咽癌患者进入同期放化疗加辅助化疗的治疗研究,放疗采用常规分割每周5次,总剂量(70～74)Gy/(35～37)次。在放疗期间第1、5周应用2个周期同期化疗(DDP25mg/m2·d-1,第1～3天和5-FU300mg/m2·d-1,第1～3天),在治疗的第10、13和16周继续3个周期辅助化疗(DDP25mg/m2·d-1,第1～3天和5-FU450mg/m2·d-1,第1～3天)。结果:67例患者中位随访时间20个月(11～27个月)。2年总生存率和无瘤生存率分别为91.75%和81.56%,Ⅲ、Ⅳ期患者2年总生存率、无瘤生存率相比差异无统计学意义(96%∶87.65%,P=0.334;92.16%∶69.35%,P=0.2358)。全部患者完成放疗,完成5个周期的化疗患者47例(70.1%),同期化疗中完成2个周期的化疗患者56例(83.6%),辅助化疗完成3个周期的化疗患者48例(71.6%)。同期放化疗期间Ⅲ度以上急性不良反应分别为:白细胞减少15例(21.4%),恶心呕吐2例(3.0%),黏膜炎症56例(83.6%),皮肤反应10例(15.0%)。辅助放化疗期间Ⅲ度以上急性不良反应分别为:白细胞减少13例(19.4%),贫血1例(1.5%)。结论:初步结果表明对于Ⅲ、Ⅳ期局部晚期鼻咽癌患者而言,该同期放化疗和辅助化疗方案依从性高,不良反应相对较低,早期疗效较好。长期疗效将进一步随访更新。Background and purpose：Concurrent chemoradiotherapy followed by adjuvant chemotherapy have been administrated to locally advance nasopharyngeal carcinoma according to the NCCN guidelines.This study s pecifically evaluated the efficacy,toxicity and compliance of modified concurrent chemoradiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma（NPC）.Methods：From Nov.2003 to Apr. 2005,67 patients with stageIIIand IVocally advanced nasopharyngeal carcinoma（NPC）were enrolled in this study.A total dosage of radiation,70-74 Gy,was given in 35-37 fractions in 5 fractions per week.Two cycles of chemotherapy, consisting of cisplatin 25 mg/m2·d-1 and 5-fluorouracil 300 mg/m2·d-1 were delivered simultaneously with radiotherapy on the day 1-3 during week 1 and 5.Three cycles of adjuvant chemotherapy,consisting of cisplatin 25 mg/m2·d-1 and fluorouracil 450 mg/m2·d-1,were also given,starting on day 1-3 during week 10,13 and 16.Results：The median follow-up was 20 months（ranged from 11 to 27 months）.The 2-year overall survival rate and the 2-year diseasefree survival rate were 91.75%and 81.56%respectively.The 2-year overall survival rate was 96%for stage IIInd 87.65%for stage IV（P=0.334）.The 2-year disease-free survival rate was 92.16%for stage IIIand 69.35%for stage IV respectively（P=0.2358）.The compliance rates were 100%for radiotherapy,47 cases（70.1%）for all chemotherapy, 56 cases（83.6%）for concurrent chemotherapy and 48 cases（71.6%）for adjuvant chemotherapy.The main grade III/IVcute toxicity events during concurrent chemoradiotherapy were neutropenia in 15 patients（21.4%）,vomitting and nausea in 2 patients（3%）,mucositis in 56 patients（83.6%）,and grade IIIkin reaction in 10（15%）,respectively. The main grade III/IVcute toxicity events during adjuvant chemotherapy were neutropenia in 13 patients（19.4%）, grade 3 anemia in 2 patients（1.5%）respectively.Conclusion：The primary result showed a good compliance,low

关 键 词：鼻咽癌 化学疗法 放射疗法 

分 类 号：R739.63[医药卫生—肿瘤] R730.53[医药卫生—临床医学]