局部晚期鼻咽癌化疗和放射综合治疗——随机临床研究  

Chemotherapy adjunctive to definitive radiotherapy in locally advanced nasopharyngeal carcinoma (NPC):prospective randomized study

作　　者：应红梅[1] 张有望[1] 胡超苏[1] 吴永如[1] 王圣忠[1] 

机构地区：[1]复旦大学附属肿瘤医院放疗科,上海200032

出　　处：《中国癌症杂志》2003年第6期563-566,共4页China Oncology

摘　　要：目的 :研究局部晚期鼻咽癌化疗和放射综合治疗的疗效及毒副反应。方法 :1995年 9月～ 1997年 7月 ,86例病理确诊为鼻咽癌、根据福州九二新分期为N2 3 的初治患者随机分组 ,综合治疗组 4 1例 ,其中 2例拒绝接受放疗后的辅助化疗 ,即综合治疗组可评估 39例 ,单纯放疗组 4 5例。综合治疗组接受 2程诱导化疗 [每天顺铂(DDP) 2 0mg/m2 ,第 1～ 3天 ,每天氟尿嘧啶 (5 FU) 5 0 0mg/m2 ,第 1～ 3天 ,第二程化疗在第 14天进行 ,放疗在第2 7天开始 )及放疗后 3程的辅助化疗。放疗为常规分割放疗。原发灶用60 Co治疗 ,每次 1 85～ 1 9Gy ,一周 5次 ,7～ 7 5周总剂量 6 5 1～ 70 3Gy/ 35～ 37次。颈部行双侧全颈根治性照射 7～ 7 5周共 5 6 6～ 6 5 5Gy/ 35～ 38次。如有残留 ,则局部缩野加量。两组鼻咽加量及颈淋巴结加量无显著差异。结果 :中位随访期 5 0 4年 ,综合治疗组和单纯放疗组五年生存率为 72 3% ,5 8 4 % ,(P =0 15 4 ) ;无瘤生存率为 5 9 9% ,4 7 7% ,(P =0 2 0 7) ;鼻咽局控率为 89 5 % ,81 4 % ,(P =0 15 1) ;颈部局控率为 88 3% ,75 2 % ,(P =0 134) ;无远处转移生存率为 76 3% ,6 0 3% ,(P =0 181) ,发生转移的中位时间分别为 1 0 8年和 0 88年。虽未?Purpose:To compare chemoradiotherapy against radiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma.Methods:From September 1995 to July 1997,eighty-six patients with histologically proven NPC who were staged according to the Fuzhou stage classification to be N 2-3 were entered. Eighty-four patients were evaluable for tumor response and survival. The patients were randomized to receive two cycles of cisplatin (DDP) 20 mg/m 2 on Days 1-3,fluorouracil (5-Fu) 500 mg/m 2 on Days 1-3,before radical radiotherapy (RT),and three cycles of postradiotherapy chemotherapy (39 patients) or radiotherapy alone (45 patients). For chemoradiotherapy (CT-RT) group,the second cycle was given on Day 14 and the radiotherapy was given on Day 27. All patients received radical radiotherapy to the nasopharynx and neck. Radiation therapy consisted of delivering 65.1-70.3 Gy in 35-37 fractions of 1.85-1.9 Gy each over 7-7.5 weeks to the primary site with external beam 60 Co in both groups. The lymph nodes of the neck were given 56.6-65.5 Gy in 7-7.5 weeks. Boost radiotherapy was given to any residual disease. The rates of radiotherapy for boosting primary site or residual lymph nodes were not significantly different in the two arms. Results:The median follow up was 5.04 years. The 5-year actuarial survival rate (ASR) was 72.3% in CT-RT arm and 58.4% in RT arm ( P =0.154). The 5-year disease free survival rate (DFS) was 59.9% in CT-RT arm and 47.7% in RT arm ( P =0.207). The 5-year free from local failure rate (FLF) in nasopharynx was 89.5% in CT-RT arm and 81.4% in RT arm respectively ( P =0.151). The 5-year FLF in neck was 88.3% in CT-RT arm and 75.2% in RT arm respectively ( P =0.134). The 5-year free from distant metastasis rate (FDM) was 76.3% in CT-RT arm and 60.3% in RT arm ( P =0.181). The median time to first distant metastasis was 1.08 years in CT-RT arm and 0.88 year in RT arm. Although the differences did not reach statistical significance,there was some benefit from adjunctive chem

关 键 词：鼻咽癌 诱导化疗 辅助化疗 放射治疗 

分 类 号：R739.6[医药卫生—肿瘤]