局部晚期鼻咽癌放疗同步ＰＦ方案或顺铂单药的临床对照研究

目的　对比观察顺铂（ＤＤＰ）单药用于局部晚期鼻咽癌同步放化疗与ＤＤＰ联合氟尿嘧啶（５-ＦＵ）方案（ＰＦ方案）同步放化疗的有效性和安全性。方法　７６例局部晚期鼻咽癌分为两组，４０例接受ＰＦ方案同步放化疗（５-ＦＵ５００ｍｇ／ｍ^２静滴，ｄ１～ｄ５；ＤＤＰ８０ｍｇ／ｍ^２静滴，ｄ１，２１天为１周期），３６例接受ＤＤＰ单药同步放化疗（ＤＤＰ４０ｍｇ／ｍ２静滴，每周１次，共７次）。鼻咽部病灶及颈部阳性淋巴结给予放疗总量为７０Ｇｙ，颈部预防性照射给予放疗量５０Ｇｙ。结果　全部患者均可评价疗效和毒副反应，ＰＦ方案组及ＤＤＰ单药组有效率均为１００％。ＰＦ方案组的１、３年生存率分别为１００％、８５％，ＤＤＰ单药组分别为１００％、８９％（Ｐ＞０.０５）；ＰＦ方案组与ＤＤＰ单药组的３年无进展生存率分别为７７.５％和７５.０％ （Ｐ＞０.０５）；ＰＦ方案组的中位生存时间为５０.６个月，ＤＤＰ单药组为４８.０个月（Ｐ＞０.０５）。两组毒副反应以恶心呕吐、口腔黏膜炎及白细胞减少为主，差异均有统计学意义（Ｐ＜０.０５）。结论　ＤＤＰ单药与ＰＦ方案用于局部晚期鼻咽癌同步放化疗的疗效相近，患者均可耐受，但ＤＤＰ单药组反应较轻。

Clinical controlled study of PF regimen or cisplatin plus concurrent radiotherapy in locally advanced nasopharyngeal carcinoma

Objective To compare the efficacy and safety of single-agent cisplatin（DDP） or DDP plus fluorouracil（5-FU） regimen（PF regimen） combined with concurrent radiotherapy for locally advanced nasopharyngeal carcinoma.Methods Seventy-six patients with locally advanced nasopharyngeal carcinoma were divided into two groups.Forty patients received chemotherapy of PF regimen jointing concurrent radiotherapy（5-FU 500mg/m2 iv d1-d5,cisplatin 80mg/m2 iv d1;21 days was a cycle）,and 36 patients received chemotherapy of single cisplatin（DDP 40mg/m2 iv once a week for a total of 7 times） with concurrent radiotherapy;nasopharyngeal lesions and positive lymph node were given a total amount of 70Gy,and prophylactic neck radiation was given the amount of 50Gy.Results The efficacy and toxicities could be evaluated.The response rate（RR） was 100% in the two groups（P0.05）.The 1-,3-year overall survival（OS） rate in PF regimen group were 100% and 85%,and in single-agent DDP group were 100% and 89%,respectively（P0.05）.3-year disease-free survival rate in PF regimen group and single-agent DDP group were 77.5% and 75.0%,respectively（P0.05）.The median OS of PF regimen group and single-agent DDP group were 50.6 months and 48.0 months（P0.05）.The main toxicities were nausea/vomiting,oral mucositis and leucopenia.The incidence of them on PF regimen group was higher than that in single-agent DDP group（P0.05）.Conclusion For patients with locally advanced nasopharyngeal carcinoma who accepted RT combining concurrent chemotherapy either DDP alone or PF regimen,the efficacy is similar and toxicities can be tolerated.The toxicities in the group of DDP alone are relatively mild.