诱导化疗对局部晚期鼻咽癌放疗远期疗效的影响

目的：探讨诱导化疗对局部晚期鼻咽癌放疗远期疗效的影响。方法：回顾性分析120例Ⅲ、1Va期鼻咽癌患者按治疗方法分为两组（化放组及单放组）。放疗采用直线加速器照射鼻咽及颈部,鼻咽剂量DT70—76Gy,7—7．5周,颈部剂量DT50—70Gy,5—7周。诱导化疗采用DDP＋5-Fu方案。结果：化放疗组1、3、5年生存率分别为98％、76％、20％;单放组分别为96％、60％、18％,无显著性差异（P〉0．05）。化放组远处转移率为20．9％,单放组为41．7％,两组比较有显著性差异（P〈0．05）。结论：诱导化疗能降低局部晚期鼻咽癌放疗的远处转移率,但没有提高生存率。     

局部区域晚期鼻咽癌同期放化疗联合辅助化疗的前瞻性Ⅲ期临床研究

目的：探讨同期放、化疗联合辅助化疗对鼻咽癌高发区人群的疗效。方法：选取中山大学肿瘤防治中心2002年7月至2005年9月316例非角化型或未分化型鼻咽癌，第五版AJCC分期为Ⅲ～ⅣB的患者入组。将患者随机分为单纯放疗组（对照组）和同期放、化疗联合辅助化疗组（试验组）。两组均采用根治性常规分割放疗。试验组患者在放疗期间同时给予Cisplatin 40mg／m^2，d1，1次/周，连续7次，放疗结束后1个月开始辅助化疗，采用Cisplatin 80mg／m^2，d1，5-FU800mg/m^2，d1～5，1次／4周，共3个疗程。结果采用意向性分析，比较两组疗效、治疗毒性及顺应性。结果：两组病例的主要预后因素包括性别、年龄、活动状态、分期方法及临床分期等，均具有可比性。试验组68.4％的患者完成了7个疗程同期化疗，84．2％的患者完成了6个疗程以上同期化疗，91．1％的患者完成了5个疗程以上同期化疗，61．4％的患者完成了3个疗程辅助化疗。试验组和对照组3级以上急性毒副反应为62．6％ vs 32.3％（P=0．000）。试验组和对照组2年总生存率、无瘤生存率、无远处转移生存率及无局部区域复发生存率分别为89．8％ vs 79．7％（P=0．003），84．6％ vs 72．5％（P=0．001），86．5％vs78．7％（P=0．024）及98．0％ vs 91．9％（P=0．007）。结论：在鼻咽癌高发区，同期放、化疗联合辅助化疗可提高局部区域晚期鼻咽癌患者总生存率、无瘤生存率、无远处转移生存率及无局部区域复发生存率，长期疗效有待进一步随访证实。     

化疗加放疗治疗晚期鼻咽癌的临床研究

目的：观察放化综合治疗晚期鼻咽癌的疗效,方法：110例Ⅲ、Ⅳa期鼻咽癌患者随机分为放疗加化疗组（综合组）和单纯放疗组（单放组）,每组55例,两组放疗方法、时间／剂量分割均相同。综合组放疗前后采用顺铂（cisplatin,DDP) -氟尿嘧啶（5－Florouracil,FU)(PF方案）化疗4－6疗程,DDP20mg.(m^2.d)^-1。静脉滴注,第1－5天,5－FU500mg.(m^2.d)^-1,静脉滴注,第1－5天,每3－4周1疗程,第1程化疗在放疗前1周进行,第2－6程化疗在放疗结束后第1天开始进行。结果：综合组和对照组5年生存率分别为65．5％和34．5％（X^2=10.51,P=0.0012),鼻咽局部控制率分别为69．1％和43．6％（X^2=7.24,P=0.0071),颈淋巴结转移控制率分别为67．3％和45．4％（X^2=5.32,P=0.021),远处转移率分别为21．8％和41．8％(X^2=5.07,P=0.0243);两组比较均有显著差异（P＜0．05）。综合组急性毒性反应较单放组重,但未影响治疗进程,结论：PF方案化疗和尽早开始放疗的交替综合治疗能提高晚期鼻咽的生存率、局部区域控制以及减少远处转移。     

三维适形放射治疗配合同期化疗治疗食管癌术后局部复发的临床研究

目的：研究同期放化疗和单纯放疗治疗食管癌术后局部复发的疗效、毒性反应和预后因数。方法：自2003年1月至2005年9月共90例食管癌术后局部复发的患者随机分为放疗组和放化组各45例。放疗组给予PTV（plan target volume）50Gy／25次,对GTV（gross target volume）推量至64Gy;同期放化疗组放疗方案同上,化疗从放射治疗的第1天开始,DDP20mg／m^2／d,5-FU500mg／m。／d,静脉注射,连用4天。放疗期间用2周期,放疗结束后再用2周期,每4周1个周期。结果：放疗组和放化组的中位生存期分别为16．4和23．5月,1、2、3年生存率分别为66．7％、31．1％、15．6％和68．9％、48．9％、35．6％（P=0．03）;完全缓解率放疗组和放化组分别为20％和53．3％（P=0．001）;远处转移率（包括远处脏器和区域外淋巴结转移）分另I为40％例和26．7％,放化组略减少了远处转移,但无显著性差异（P=0．18）。多因数分析显示多发转移、没有化疗、病灶大于4cm生存率较差;急性毒性反应放化组高于放疗组（P〈0．05）。结论：食管癌术后区域性复发同期放化疗,能明显提高局部病灶的完全缓解率,略减少了远处转移,提高了总生存率,但毒性反应增加。     

鼻腔非霍奇金淋巴瘤的化学治疗及放射治疗

目的 探讨不同治疗方法对鼻腔非霍奇金淋巴瘤(NHL)患者的预后影响。方法 在59例原发于鼻腔NHLIE期患者中,化疗 放疗33例,放疗 化疗8例,单纯化疗10例,单纯放疗8例,化疗方案为CHOP.结果 全组患者的l,3,5年生存率分别为71．2％、42．0％和38．5％,不同治疗方法的生存率差异无显著性(P=0．3943),但生存曲线显示,放化组优于其他组。临床分期显示,Ig局限组患者l,3,5年生存率为84．2c／／,67．7％和62．0%,,Ig超腔组患者为50．0％、14．3％和14．3％,差异有显著性(P=0．0012)。首程化疗≥3个周期24例,首程放疗≥40 Gy16例,CR率分别为25．0v／／,和75．0％,筹异有显著性(P=0．002)。首程化疗2,3～4,5～6个周期的CR率分别为10．5％、25．0％和25．0％,差异无显著性(P=0．48)。并发症发生率及治疗相关死亡率均以化放组为高(39．4％,15．2％),但差异无显著性(P=0．202,P=0．693)。结论 Ⅰ期鼻腔NHL患者首选放疗,以尽早达到局部控制,再根据临床分期及恶性程度或国际预后指数(IPI)酌情给予更有效的化疗方案。     

放疗同步化疗治疗晚期鼻咽癌的临床疗效观察

目的：探讨放疗同步化疗治疗晚期鼻咽癌的疗效及毒副反应。方法：92例病理证实的晚期鼻咽癌病例随机分为单纯放疗组46例，放疗同步化疗组46例，单纯放射治疗，鼻咽原发灶DT70Gy，颈部预防照射DT50Gy，转移灶DT65-70Gy。同步化疗，DDP 30mg静脉滴注，第1－3天，5－FU0.5静脉滴注，第1－3天，21天为一周期，连用二周期。结果：5年生存率，单纯放疗组32．6％，放疗同步化疗组58．17，有显著差异P＜0．05。其毒副反应为胃肠道反应，口腔粘膜反应，白细胞减少等，均对症处理后，能完成放疗计划。结论：放疗同步化疗能提高晚期鼻咽癌的5年生存率和降低远处转移率，延长生存期。     

后程三维适形放疗在鼻咽癌缩野放疗中的临床研究

目的：观察后程三维适形放疗在鼻咽癌缩野放疗中的近期疗效及副作用。方法：将84例初治无远处转移的鼻咽癌患者用信封法随机分为后程三维适形放疗组（观察组）和常规疗放疗组（对照组）。两组病例第一段采用面颈联合常规低熔点铅挡块野放疗36Gy／18次，加下颈前切线野放疗36Gy／18次；第二段采用双侧耳前野放疗10Gy／5次，第三段采用三维适形野放疗20Gy／10次；加全颈前切线野放疗14—4Gy／7—12次，颈淋巴结残局部补量10Gy／5次。鼻咽总剂量70Gy-74Gy；颈部剂量，淋巴结阴性50Gy；阳性70Gy。结果：两组病例完全缓解率、1年生存率分别为97．6％、100％和90．5％、92．9％。两组肿瘤的局控率差异有统计学意义（P〈0．05），生存率差异无统计学意义（P〉0．05）。结论：鼻咽癌后程三维适形放疗较常规放疗有较好的肿瘤局控率，且副反应较轻。     

食管癌伴区域淋巴结受累的放疗和化疗临床结果

目的：比较同期放化疗和放疗后化疗治疗区域淋巴结肿大食管癌的疗效和毒性反应。分析区域淋巴结肿大的食管癌放化疗后失败原因。方法：自1998年8月—2000年8月，对65例区域淋巴结肿大的食管癌随机分成两组。放疗后化疗组33例，同期放化疗组32例。两组放疗均采用常规分割放射治疗，总剂量60-70Gy，化疗均采用DF方案(顺铂40mg，第1—3天，5—FU500mg／m^2，第1—3天)，放疗后化疗在放射治疗结束后第15天起按计划每28天给1周DF方案化疗，同期放疗组在放射治疗第1天起给予DF方案化疗，以后每隔28天化疗1周期，每例患者化疗不少于4周期。结果：同期放化疗一、二和三年生存率分别为60．2％、43．5％和25．9％。放疗后化疗的一、二和三年生存率分别为66．3％、22．5％和11．3％(P＝0．109)。Ⅲ度以上放射性食管炎发生率，放疗后化疗组为18．2％(6／33)，同期放化疗组为43．7％(14／32)，两组差异有显著性意义(P＜0．05)。结论：同期放化疗治疗区域淋巴结肿大食管癌的三年生存率比放疗后化疗有提高的趋势，但Ⅲ度以上放射性食管炎的发生率也有明显增高。     

立体定向放疗联合FOLFOX4化疗治疗无法手术的复发性直肠癌的近期疗效观察

目的探讨立体定向放疗联合FOLFOX4化疗治疗无法手术的复发性直肠癌的临床疗效。方法无法手术的复发性直肠癌48例接受立体定向放疗：既往未接受盆腔放疗病例，常规盆腔前后野或三野外照射DT40Gy，然后针对复发病灶行立体定向放疗总剂量DT56-66Gy（中位剂量60Gy）；曾接受盆腔放疗病例，直接针对复发病灶行立体定向放疗DT36～46Gy（中位剂量40Gy）。治疗组联合FOLFOX4方案化疗：其中接受全盆腔照射者，在放射治疗开始第1周和第5周予FOLFOX4化疗2周期；直接行适形放疗者，于放疗第1周和最后1周予FOLFOX4化疗2周期。放疗结束后2～3周开始序贯FOLFOX4化疗2～4周期（平均3．6周期）。记录两组症状缓解情况、近期疗效、远期疗效和毒副反应。结果治疗组和对照组疼痛缓解率分别为95．2（20／21）％和91．3％（21／23）（P〉0．05）；治疗组和对照组总有效率分别为56．5％和40．0％（P〉0．05）；1、2年生存率分别为86．9％、50．2％和80．0％、23．9％，中位生存期分别为25个月和16个月（P〈0．05）；2年远处转移率分别为39．1％和56．0％（P=0．054）。两组患者的毒副反应除外周神经毒性外无明显差异，毒副反应较轻，基本可以耐受。结论立体定向放疗联合FOLFOX4化疗治疗无法手术的复发性直肠癌安全可行，可望减少远处转移的发生和改善生存率。     

同期化疗配合后程三维适形放疗治疗食管癌的临床观察

目的：观察同期化疗配合后程三维适形放疗治疗食管癌的缓解率、局控率、生存率和毒副反应。方法：79例食管癌患者随机分为两组，放化疗组（39例）大野前后对穿常规分割照射36Gy-40Gy后，缩野三维适形照射追量26Gy，在放疗开始和放疗末期用氟脲嘧啶500mg／m^2＋顺铂20mg／m^2第1—5天全身化疗。单放组（40例）大野前后对穿常规分割照射36Gy-40Gy后，缩野照射追量26Gy。两组放疗总量62Gy-66Gy。结果：放化疗组与单放组完全缓解率分别为33％、12．5％（P〈0．05）。1、2年生存率放化疗组为79％、59％，单放组为68％、42％（P=0．13）。毒性反应放化疗组相对增加，但绝大多数患者可以耐受。结论：同期化疗配合后程三维适形放疗治疗食管癌近期疗效较好，可提高生存率。毒副反应增加，但可以耐受。     

Phase III study comparing standard radiotherapy with or without weekly oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma: preliminary results.

PURPOSE: A prospective, randomized, phase III study was performed to evaluate the feasibility and efficacy of concurrent weekly oxaliplatin with radiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS: From January 2001 to January 2003, 115 patients with locoregionally advanced NPC were randomly assigned to either radiotherapy (RT) alone (56 patients) or concurrent chemoradiotherapy (CCRT; 59 patients). All patient characteristics were well balanced in both arms. CCRT with oxaliplatin 70 mg/m2 weekly was administered for six doses from the first day of RT. RESULTS: All patients were eligible for toxicity and response analysis. Compliance with the protocol treatment was excellent, with 97% of patients completing all planned doses of oxaliplatin, and a lack of high-grade toxicity was observed. After a median follow-up time of 24 months, there was a significant difference in overall survival (OS), relapse-free survival (RFS), and metastasis-free survival (MFS) in favor of the CCRT arm. The 2-year OS rates were 100% for the CCRT arm and 77% for the RT arm (P = .01). The 2-year MFS rates were 92% for the CCRT arm and 80% for the RT arm (P = .02). The 2-year RFS rates were 96% for the CCRT arm and 83% for the RT arm (P = .02). CONCLUSION: CCRT with weekly oxaliplatin is feasible and improves OS, MFS, and RFS rates in patients with locoregionally advanced NPC. Therefore, further randomized trials including oxaliplatin are warranted.     

Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of china

PURPOSE: A prospective randomized trial was performed to evaluate the efficacy of concurrent chemotherapy and adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) in endemic regions of China. METHODS AND MATERIALS: Between July 2002 and September 2005, 316 eligible patients were randomly assigned to receive either radiotherapy alone (RT) or chemoradiotherapy concurrent with adjuvant chemotherapy (CRT). All patients received 70 Gy in 7 weeks using standard RT portals and techniques. The CRT patients were given concurrent cisplatin (40 mg/m(2) on Day 1) weekly during RT, followed by cisplatin (80 mg/m(2) on Day 1) and fluorouracil (800 mg/m(2) on Days 1-5) every 4 weeks (Weeks 5, 9, and 13) for three cycles after completion of RT. All patients were analyzed by intent-to-treat analysis. RESULTS: The two groups were well-balanced in all prognostic factors and RT parameters. The CRT group experienced significantly more acute toxicity (62.6% vs. 32%, p = 0.000). A total of 107 patients (68%) and 97 patients (61%) completed all cycles of concurrent chemotherapy and adjuvant chemotherapy, with a median follow-up time of 29 months. The 2-year overall survival rate, failure-free survival rate, distant failure-free survival rate, and locoregional failure-free survival rate for the CRT and RT groups were 89.8% vs. 79.7% (p = 0.003), 84.6% vs. 72.5% (p = 0.001), 86.5% vs. 78.7% (p = 0.024), and 98.0% vs. 91.9% (p = 0.007), respectively. CONCLUSIONS: This trial demonstrated the significant survival benefits of concurrent chemotherapy plus adjuvant chemotherapy in patients with locoregionally advanced NPC in endemic regions of China.     

Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma.

PURPOSE: A prospective randomized trial was performed to evaluate the contribution of neoadjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. PATIENTS AND METHODS: Patients with locoregionally advanced nasopharyngeal carcinoma were treated either with radiotherapy alone (RT group) or neoadjuvant chemotherapy plus radiotherapy (CT/RT group). Neoadjuvant chemotherapy consisting of two to three cycles of cisplatin (100 mg/m(2), day 1), bleomycin (10 mg/m(2), days 1 and 5), and fluorouracil (5-FU; 800 mg/m(2), days 1 through 5, continuous infusion) followed by radiotherapy was given to the CT/RT group. All patients were treated in a uniform fashion by definitive-intent radiation therapy in both groups. RESULTS: Between July 1993 and July 1994, 456 patients were entered onto the study, with 228 patients randomized to each treatment arm, and 449 patients (225 in the RT group and 224 in the CT/RT group) were assessable. All 456 patients were included in survival analysis according to the intent-to-treat principle. The 5-year overall survival (OS) rates were 63% for the CT/RT group and 56% for the RT group (P =.11). The median relapse-free survival (RFS) time was 50 months for the RT group and not reached for the CT/RT group. The 5-year RFS rate was 49% for the RT group versus 59% for the CT/RT group (P =.05). The 5-year freedom from local recurrence rate was 82% for the CT/RT group and 74% for the RT group (P =.04). There was no significant difference in freedom from distant metastasis between the two treatment groups (CT/RT group, 79%; RT group, 75%; P =.40). CONCLUSION: This randomized study failed to demonstrate any significant survival benefit with the addition of neoadjuvant chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma. Therefore, neoadjuvant chemotherapy for nasopharyngeal carcinoma should not be used outside of the context of a clinical trial.     

A randomized trial of induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus radiotherapy for locoregionally advanced nasopharyngeal carcinoma

The aim of this randomized study was to compare the efficacy of induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT) versus induction chemotherapy plus radiotherapy (IC+RT) for patients with locoregionally advanced nasopharyngeal carcinoma. From August 2002 to April 2005, 408 patients were randomly divided into two groups: an IC+CCRT group and an IC+RT group. Patients in both groups received the same induction chemotherapy: two cycles of floxuridine (FuDR)+carboplatin (FuDR, 750mg/m(2), d1-5; carboplatin, area under the curve [AUC]=6). The patients received radiotherapy 1week after they finished the induction chemotherapy. The patients in the IC+CCRT group also received carboplatin (AUC=6) on days 7, 28, and 49 of radiotherapy. Eight patients did not meet the inclusion criteria, and the remaining 400 cases were analyzed. Grade III or IV toxicity was found in 28.4% of the patients in the IC+CCRT group and 13.1% of those in the IC+RT group (P<.001). Five-year overall survival rates were 70.3% and 71.7% (P=0.734) in the IC+CCRT and IC+RT groups, respectively. No significant differences in failure-free survival, locoregional control, and distant control were found between the two groups. Compared with the IC+RT program, the IC+CCRT program used in the present study did not improve the overall survival and failure-free survival in patients with locoregionally advanced nasopharyngeal carcinoma. Using carboplatin in the concurrent chemoradiotherapy was not suitable for nasopharyngeal carcinoma.     

Role of chemoradiotherapy in intermediate prognosis nasopharyngeal carcinoma

To evaluate the long term impact of concurrent chemoradiotherapy (CCRT) compared to radiotherapy (RT) alone in patients with T2N1M0 nasopharyngeal carcinoma (NPC) retrospectively. Three hundred and ninety-two patients with T2N1M0 NPC according to the AJCC 2002 stage classification system were analyzed. Among them, 211 patients were treated with RT alone and the rest of 181 patients were treated with CCRT. A planned dose of 70 Gy was delivered in 2.0 Gy per fraction over 7 weeks to the primary tumor with 6-MV photons or (60)Cobalt γ-ray. The chemotherapy regimen of cisplatin with a dose of 100mg/m(2) was delivered for 2-3 cycles. With a median follow-up of 66 months (range 2.4-117.1 months), the 5-year overall survival (OS) and disease-free survival (DFS) rates was higher in CCRT group compared to RT alone group, though they failed to reach statistical significance (80.2% vs. 76.6%, P=0.778 and 70.5% vs. 64.2%, P=0.413, respectively). A significant improvement was detected in 5-year relapse-free survival (RFS) rate in CCRT group than RT alone group (91.5% vs. 77.3%, P=0.008). Moreover, chemotherapy was the only independent prognostic factor for the 5-year RFS (P=0.007). Concurrent chemoradiotherapy appeared to improve the 5-year RFS rate for patients with T2N1M0 NPC. Large prospective, randomized clinical studies are needed to confirm its therapeutic gain.     

TPF诱导化疗或PF诱导化疗联合同期放化疗治疗局部晚期鼻咽癌的临床观察

背景与目的：TPF(多西他赛+顺铂+氟尿嘧啶)诱导化疗加同期放化疗治疗局部晚期鼻咽癌的疗效尚不清楚。该研究旨在比较TPF诱导化疗或PF(顺铂+氟尿嘧啶)诱导化疗联合同期放化疗治疗局部晚期鼻咽癌的疗效和耐受性。方法：将局部晚期鼻咽癌患者随机分为两组。TPF组116例接受TPF诱导化疗(多西他赛60 mg/m2,第1天+顺铂60 mg/m2,第1天+氟尿嘧啶750 mg/m2,持续静脉滴注120 h),每3周重复,共3个疗程。PF组116例接受PF诱导化疗(顺铂80 mg/m2,第1天+氟尿嘧啶750 mg/m2,持续静脉滴注120 h),每3周重复,共3个疗程。诱导化疗结束后行同期放化疗,放疗采用调强适形放疗(intensity modulated radiation therapy,IMRT)技术,大体肿瘤靶区(gross tumor volume,GTV)6810 cGy/30次,5次/周,共6周,同期化疗用顺铂80 mg/m2,第1、22天。评价完全缓解(complete response,CR)、部分缓解(partial response,PR)和有效缓解率(response rate,RR), RR=CR+PR。评价两组患者的近期疗效及不良反应,并随访比较5年无进展生存(progression-free survival,PFS)和5年总生存(overall survival,OS)。结果：诱导化疗结束后和治疗结束后13周TPF组的有效缓解率都高于PF组,两组差异有统计学意义(P=0.001,P=0.002);TPF组中位复发时间为2.98年,5年的PFS为84.48%,PF组中位复发时间为2.32年,5年的PFS为82.75%,差异无统计学意义(P=0.458);TPF组5年的OS为87.06%,PF组5年的OS为85.34%,差异无统计学意义(P=0.274)。TPF组在中性粒细胞下降、血小板下降、肝功能和肾功能损伤、腹泻以及黏膜坏死的发生上均明显高于PF组,差异有统计学意义(P<0.001),TPF组发生Ⅲ度和Ⅳ度不良反应较PF组明显增高,差异有统计学意义(P<0.001)。结论：TPF方案诱导化疗治疗局部晚期鼻咽癌的临床疗效并不优于PF方案诱导化疗治疗局部晚期鼻咽癌,且TPF方案诱导化疗的不良反应较PF方案明显,临床上不适合推广。     

Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma

This phase III randomized study compared concurrent cisplatin-radiotherapy (CRT) versus radiotherapy (RT) alone in patients with locoregionally advanced nasopharyngeal carcinoma. A total of 350 patients were randomly assigned to receive external RT alone or concurrently with cisplatin at a dosage of 40 mg/m(2) weekly. The primary endpoint was overall survival, and the median follow-up was 5.5 years. The 5-year overall survival was 58.6% (95% confidence interval [CI] = 50.9% to 66.2%) for the RT arm and 70.3% (95% CI = 63.4% to 77.3%) for the CRT arm. In Cox regression analysis adjusted for T stage, age, and overall stage, the difference in overall survival was statistically significantly in favor of concurrent CRT (P = .049, hazard ratio [HR] = 0.71 [95% CI = 0.5 to 1.0]). Subgroup analysis demonstrated that there was no difference between overall survival in the arms for T1/T2 stage (P = .74, HR = 0.93 [95% CI = 0.59 to 1.4]), whereas there was a difference between the arms for T3/T4 stage (P = .013, HR = 0.51 [95% CI = 0.3 to 0.88]), favoring the CRT arm. The regimen of weekly concurrent CRT is a promising standard treatment strategy for locoregionally advanced nasopharyngeal carcinoma patients.     

Concurrent chemoradiotherapy with protracted infusion of 5-FU and cisplatin for postoperative recurrent or residual esophageal cancer

BACKGROUND: We carried out the present study to investigate the feasibility and effectiveness of concurrent chemoradiotherapy (CT-RT) for postoperative recurrent esophageal cancer, which are, at present, unclear. METHODS: Between 1998 and 2002, 16 patients with postoperative loco-regional recurrence of esophageal cancer, and two patients with incompletely resected esophageal cancer were treated with concurrent CT-RT. Patients received protracted infusion of 5-FU 250-300 mg/m(2) on days 1 to 14, 1 hour infusion of cisplatin 10 mg/body on days 1 to 5 and 8 to 12, and a concurrent radiotherapy (RT) dose of 30 Gy in 15 fractions over 3 weeks. This treatment schedule was repeated twice with a gap of 1 week, for a total RT dose of 60 Gy administered over 7 weeks. RESULTS: Of the 18 patients, 13 (72%) completed the CT-RT protocol. A total RT dose of 60 Gy was administered for all except two patients, and doses of chemotherapy were reduced for five patients. Although grade 3 hematological toxicities were frequently noted, non-hematological toxicities of grades 3 and 4 were few. Of the 18 tumors, five (28%) showed complete response (CR). For patients without prior chemotherapy, the CR rate was 40% (4/10). The 2-year survival rate of 13 patients without distant metastases was 19%, with a median survival time of 9.5 months. CONCLUSION: The concurrent CT-RT protocol appears feasible and effective for patients with postoperative recurrent or residual esophageal cancer.     

中晚期鼻咽癌新辅助化疗联合放疗前瞻性 临床试验的长期结果

目的：评价新辅助化疗联合放疗在中晚期鼻咽癌治疗的价值。方法：前瞻性临床试验采用化疗方案：Cisplatin20mg/m^2,1-5天,5－FU500mg/m^2,1-5 天,BLM7mg/m^2,第1、5天,化疗2－3个疗程。放射治疗鼻咽剂量：66－74Gy/33-37次,共7－9周;预部淋巴结剂量：60－70Gy/30-35次,共7－8.5周;颈部预防量：48－50Gy。结果：1992－1993年457例鼻咽癌病人进入研究,17例因各种原因退出队列,440例进入分析（化疗＋放疗组219例、单纯放疗组221例）。5年生存率及无瘤生存率实验组及对照组分别为62％vs55％（P＝0.1335)及55％vs48%(P=0.0539)。5年无局部复发生率及无远处转移生存率两组分别为82％vs74%（P＝0.0412)及79％vs75%(P=0.4177)。亚组分析显示新辅助化疗能明显提高T3－4期的局控率;对N2－3病人的远处转移率无影响。结论：新辅助化疗未能提高中晚期鼻咽癌病人的总生存率,亦未能降低远处转移率,有提高无瘤生存率的趋势。新辅助化疗的指征：T3－4期病人。