诱导化疗加放疗与同期放化疗治疗局部晚期鼻咽癌的疗效比较  

Efficacy of Induction Chemotherapy plus Radiotherapy versus Concurrent Chemoradiotherapy for Locally Advanced Nasopharyngeal Carcinoma

作　　者：夏海群[1] 华贻军[1] 彭醒思 黄培钰[1] 曹卡加[1] 

机构地区：[1]中山大学肿瘤防治中心,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广东广州510060

出　　处：《中国肿瘤》2016年第5期386-390,共5页China Cancer

摘　　要：[目的]比较诱导化疗加放疗与同期放化疗治疗局部晚期鼻咽癌的疗效。[方法]收集2007年1月至2009年12月中山大学附属肿瘤医院收治的经病理证实的局部晚期鼻咽癌258例,其中采用顺铂+5-Fu诱导化疗加调强放疗(诱导组)128例,采用顺铂同期放化疗(同期组)130例。应用Kaplan-Meier和Log-rank方法计算和比较两组患者的生存率,应用COX风险回归模型进行预后多因素分析。[结果]诱导组和同期组5年总生存率(83.1%vs 83.0%)、无瘤生存率(80.9%vs 79.1%)、无转移生存率(84.9%vs 83.6%)、无复发生存率(95.0%vs 92.8%)比较差异均无统计学意义(P>0.05)。同期组3、4级恶心呕吐的发生率明显高于诱导组(10%vs1.6%,P=0.004),体重下降的平均数也明显大于诱导组(P<0.001)。多因素分析结果显示N分期是影响局部晚期鼻咽癌总生存的独立因素。[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,但同期放化疗的消化道反应较重。远处转移是局部晚期鼻咽癌治疗失败的主要原因。[Purpose] To compare the efficacy of induction chemotherapy plus intensity modulated radiotherapy（IMRT） with concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma（NPC）. [Methods] Clinical data of 258 patients with locally advanced NPC treated in Sun Yat-sen University Cancer Center from January 2007 to December 2009 were retrospectively reviewed. Among 258 patients,128 received induction chemotherapy followed by IMRT（ICRT group）,130 were treated with concurrent chemoradiotherapy（CCRT group）. The chemotherapy regimen for ICRT group included cisplatin and 5-fluorouracil（5-Fu）,and for CCRT group was cisplatin.The survival were calculated by Kaplan-Meier method and compared with Log-rank test. The multivariate analyses were conducted by Cox proportional hazard regression model. [Results] The 5-year overall survival（OS）,disease-free survival（DFS）,distant metastasis-free survival（DMFS） and recurrence-free survival（RFS） of the ICRT and CCRT groups were 83.1% and 83.0%,80.9% and79.1%,84.9% and 83.6%,95.0% and 92.8%,respectively,there were no significant differences in survival between the two groups（P〉0.05）. The rate of grade 3,4 nausea-vomiting in CCRT group was significantly higher than that in ICRT group（10% vs 1.6%,P=0.004）. The average reduction of body weight during the treatment was higher in CCRT group than that in ICRT group（P 0.001）.Multivariate analysis showed that N stage was independent prognostic factors for OS of patients with locally advanced NPC. [Conclusion] The treatment outcomes of induction chemotherapy plus IMRT and concurrent chemoradiotherapy are similar,but the digestive tract reaction is heavier in CCRT group. Distant metastasis remained the main cause of treatment failure.

关 键 词：鼻咽癌 调强放疗 诱导化疗 同时期放化疗 

分 类 号：R739.63[医药卫生—肿瘤]