Patterns of failure after induction chemotherapy and radiotherapy for locoregionally advanced nasopharyngeal carcinoma: the Queen Mary Hospital experience

Purpose: Our center contributed 183 patients to the Asian–Oceanian Clinical Oncology Association (AOCOA) multicenter randomized trial comparing induction chemotherapy (CT) followed by radiotherapy (RT) vs. RT alone in patients with locoregionally advanced undifferentiated nasopharyngeal carcinoma (NPC). In a preliminary report no difference in terms of overall survival or relapse-free survival was found between the 2 treatment arms. To study the long-term outcome and patterns of failure after CT for NPC, we analyzed our own center data for which a uniform radiation treatment protocol was adopted and a longer follow-up time was available.

Methods and Materials: Between September 1989 and August 1993, a total of 183 patients were recruited into the AOCOA randomized study from our center. Patients with newly diagnosed NPC of Ho’s T3 disease, N2–N3 disease, or with neck node size of at least 3 cm were eligible. Stratification was made according to the nodal size (≤ 3 cm, >3– 6 cm, > 6 cm). Patients were randomized to receive 2–3 cycles of CT with cisplatin 60 mg/m² and epirubicin 110 mg/m² D1 followed by RT or RT alone. Four patients were excluded from the current analysis (2 died before treatment, 2 received treatment elsewhere). The remaining 179 patients were randomized to the two treatment arms, with 92 to the CT arm and 87 to the RT arm. Two patients in the CT arm had RT only, and all patients completed radiation treatment. Overall survival (OAS), relapse-free survival (RFS), local relapse-free survival (LRFS), nodal relapse-free survival (NRFS), and distant metastases-free survival (DMFS) were analyzed using Kaplan–Meier method and significance of survival curve differences calculated using log–rank test. Analysis was performed based on the intent-to-treat.

Results: The median follow-up was 70 months. At the time of analysis, 50% of patients in the CT arm and 61% in the RT arm had relapse, while 32% in the CT arm and 36% in the RT arm had died of the disease. The median RFS was 83 months in the CT arm and 37 months in the RT arm. The median OAS has not yet been reached for both arms. No significant differences were found for the various endpoints, although there was a trend suggesting better nodal control in the CT arm. The 5-year rates for the various endpoints in the CT arm vs. the RT arm were: 53% vs. 42% for RFS (p = 0.13), 70% vs. 67% for OAS (p = 0.68), 80% vs. 77% for LRFS (p = 0.73), 89% vs. 80% for NRFS (p = 0.079), and 70% vs. 68% for DMFS (p = 0.59). There was also no significant difference in the patterns of failure between both arms: in the CT arm, 28% of failures were local only, 13% regional only, 4% locoregional, 44% distant, and 11% mixed locoregional and distant. In the RT arm, 23% of failures were local only, 13% regional only, 11% locoregional, 43% distant, and 9% mixed locoregional and distant.

Conclusion: Induction chemotherapy with the regimen used in the current study did not improve the treatment outcome or alter the failure patterns in patients with locoregionally advanced NPC, although there was a trend suggesting better nodal control in the combined modality arm. Alternative strategies of combining chemotherapy and radiotherapy should be tested and employed instead.     

诱导化疗和放射治疗配合治疗晚期鼻咽癌

目的评价化放结合和单独放疗治疗局部晚期鼻咽癌的近期疗效和毒副作用.方法化放组先诱导化疗二疗程后放疗,化疗用顺铂10mg,第1～3天,5-Fu 750mg,第1～3天,静脉点滴,第10天重复,化疗后一周开始放疗,单放组单独放疗.结果化放组肿瘤消退率为90%,单放组为70%,有明显差异;化放组毒副作用与单放组无显著差异.结论化放结合明显提高了肿瘤的消退率,但远期疗效还有待于进一步随诊.     

紫杉醇和顺铂新辅助化疗联合放疗治疗局部晚期鼻咽癌疗效观察

目的研究紫杉醇加顺铂方案(TP)新辅助化疗联合放疗治疗晚期鼻咽癌的临床疗效。方法1998年1月至2001年1月57例病理确诊为鼻咽癌,根据福州1992年分期标准,57例均为Ⅲ、Ⅳa期的初治患者,随机分为综合组27例,单放组30例。综合组行TP方案新辅助化疗2个疗程后放疗。结果综合组与单放组鼻咽全消率分别为96.3%和83.0%(P<0.05),颈部淋巴结全消率分别为100%和93.3%(P>0.05)。综合组胃肠道反应、口腔黏膜反应、皮肤反应及白细胞减少等毒副反应均强于单放组,但差异无显著性(P>0.05)。综合组5年生存率(59.3%)与单放组(43.3%)相比差异无显著性(P>0.05)。结论TP方案新辅助化疗联合放疗可提高肿瘤局控率,未能提高晚期鼻咽癌生存率。     

A phase III study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients

To evaluate the role of adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma (NPC) patients, we conducted a randomized Phase III trial comparing radiotherapy (RT) followed by adjuvant chemotherapy to RT alone in patients with advanced NPC.

Between November 1994 and March 1999, 157 patients with Stage IV, M₀ (UICC/AJCC, 1992) advanced NPC disease were randomized to receive standard radiotherapy, as follows: 35–40 fractions, 1.8–2.0 Gy/fraction/day, 5 days/week, to a total dose 70–72 Gy with or without 9 weekly cycles of 24-h infusional chemotherapy (20 mg/m² cisplatin, 2,200 mg/m² 5-fluorouracil, and 120 mg/m² leucovorin) after RT. Of 157 patients enrolled, 154 (77 radiotherapy, 77 combined therapy) were evaluable for survival and toxicity analysis.

With a median follow-up of 49.5 months, the 5-year overall survival and relapse-free survival rates were 60.5% vs. 54.5% (p = 0.5) and 49.5% vs. 54.4% (p = 0.38) for the radiotherapy-alone group and the combined radiotherapy and adjuvant chemotherapy group, respectively. The Cox regression showed that the hazard rates ratio of combined treatment to RT alone was 0.673 (p VALUE = 0.232); the 95% confidence interval was 0.352 and 1.288, respectively. Patients who received combined treatment had a lower systemic relapse rate than radiotherapy-alone patients, according to relapse pattern analysis. The incidence of leukopenia (≥ Grade 3) occurred in 17 out of 819 (2.1%) cycles of weekly chemotherapy. No patient developed moderate to severe mucositis (≥ Grade 3).

We conclude that adjuvant chemotherapy after RT for patients with advanced NPC has no benefit for overall survival or relapse-free survival.     

鼻咽癌放疗前行介入灌注化疗的临床疗效分析

目的探讨在鼻咽癌放疗前行经导管动脉灌注化疗的临床应用价值.方法 43例鼻咽癌患者经颌内动脉和咽升动脉灌注化疗药物进行治疗,主要药物为顺铂、5-Fu和平阳霉素.术后一周常规放疗.以同期行单纯放疗的65例鼻咽癌患者作为对照组.结果治疗组与对照组完全缓解率分别为74.41%和60.0%.结论鼻咽癌放疗前行经导管动脉灌注化疗的安全、有效.     

中国西北地区早期鼻咽癌调强放疗联合化疗的临床研究

目的 分析生长在西北地区的早期鼻咽癌(T_1~2N_0~1期)患者调强放疗联合化疗的疗效及预后因素。方法 回顾分析2006—2009年本院收治的 58例早期鼻咽癌患者临床资料。Kaplan-Meier法计算生存率,并Logrank法检验和单因素分析。结果 随访率100%,随访满2、3年者分别为50、46例。全组1、2、3年生存率分别为98%、94%、91%。分层分析显示T₁N_0~1、T₂N₀期与T₂N₁期 3年总生存率、局部无复发生存率、无远处转移生存率不同,分别为100%和74%、100%和81%、100%和87%(χ²=5.74、4.95、4.24,P=0.01、0.03、0.04);全组放化疗与单纯放疗的不同,分别为100%与85%、100%与85%、100%与88%(χ²=4.02、4.12、4.84,P=0.04、0.03、0.02);T₂N₁期中放化疗与单纯放疗的也不同,分别为100%与79%、100%与79%、100%与80%(χ²=5.28、4.84、4.72,P=0.03、0.04、0.04)。单因素分析显示N分期、临床分期、放化疗与生存相关(χ²=5.39、5.74、4.02,P=0.02、0.01、0.04)。结论 早期鼻咽癌各亚组中T₂N₁期是远处转移的高危亚组,调强放疗联合化疗可能提高该组病例的无复发生存率、无远处转移生存率及总生存率。     

Tumor volume is not an independent prognostic factor in early-stage nasopharyngeal carcinoma treated by radiotherapy alone

PURPOSE: To determine whether the tumor volume can predict the treatment outcome in early-stage nasopharyngeal carcinoma (NPC) treated by radiotherapy alone. METHODS AND MATERIALS: The pretreatment CT scans of 116 patients with American Joint Committee on Cancer Stage I-II NPC treated by radiotherapy alone were retrospectively reviewed. The clinician outlined the tumor extent. The primary tumor volume (PTV) and nodal volume (NV) were then calculated by a summation-of-areas technique. The PTV and NV were correlated with locoregional control, distant failure, and survival. The median follow-up time was 105 months. RESULTS: Patients with Stage I disease had a 5-year locoregional control rate of 95% and a disease-specific survival (DSS) rate of 97%; for Stage II disease, the corresponding rates were 81% and 79%. The PTV ranged from 1.3 to 75.5 cm3 (median, 12.6 cm3), with substantial overlap between T1 and T2 disease. The NV ranged from 0 to 35.4 cm(3). Patients with a PTV >15 cm3 had significantly worse local control (5-year control rate, 82% vs. 93%; p = 0.033), but no statistically significant difference was noted in survival (5-year DSS rate, 83% vs. 89%; p = 0.30). The difference in local control was mainly seen in those with T2 disease. Patients with NV >4 cm3 had a greater distant failure rate (5-year distant metastasis-free rate, 72% vs. 90%; p = 0.011) and worse survival (5-year DSS rate, 76% vs. 94%; p = 0.0038). Nodal control was excellent with no difference between a NV of < or =4 cm3 and a NV of >4 cm3 (5-year control rate, 97% vs. 100%). The survival rate was worst in patients with a PTV >15 cm3 and a NV >4 cm3 (5-year DSS rate, 68%) and best in those with a PTV of < or =15 cm3 and a NV of < or =4 cm3 (5-year DSS rate, 92%). Multivariate analysis, however, showed that only parapharyngeal extension (T2b) and N1 stage were independent factors that predicted locoregional control and survival, and N1 stage was the only factor that predicted distant failure. CONCLUSION: The pretreatment tumor volume has a limited prognostic value in early-stage NPC compared with the usual T and N classification, with Stage T2b and N1 as independent factors that predicted treatment outcome. Within T2 disease, the estimation of tumor volume may identify a subgroup of patients with a greater risk of local failure that warrants more aggressive treatment.     

紫杉醇、顺铂及卡培他滨联合放疗治疗晚期鼻咽癌的疗效观察

目的 探讨紫杉醇、顺铂及卡培他滨方案 （TPX）联合放疗治疗晚期鼻咽癌的疗效及安全性。方法 2002年2月至2007年9月收治57例Ⅲ、ⅣA期鼻咽癌患者,先予直线加速器常规放疗,鼻咽原发灶2Gy／f,每周5次,DT 70Gy,7周完成。放疗后2周,29例给予TPX方案化疗（紫杉醇175mg／m²静滴,d₁;顺铂 25mg／m²静滴,d₁～d₃;卡培他滨1.5g／m²口服,d₁～d₁₄,3周为1周期）;另28例给予TP方案化疗（紫杉醇175mg／m² 静滴,d₁;顺铂25mg／m²静滴,d₁～d₃,3周为1周期）。两组均化疗4周期。化疗完成后对两组的近期疗效和总生存期进行比较。结果 TPX组和TP组的总有效率（RR）分别为96.5％和92.9％（P＞0.05）;3年生存率分别为82.8％和57.1％（P＜0.05）;3年远处转移率分别为 24.1％和50.0％ （P＜0.05）;PTX组骨髓抑制、胃肠道反应、神经毒性及肝肾功损害等毒副反应与TP组相近（P＞0.05）,手足综合征高于TP组（P＜0.05）。结论 TPX方案较TP方案联合放疗能提高晚期鼻咽癌的生存率,减少远处转移,且化疗毒副反应可以耐受。     

Long-term survival of nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy

Purpose: The purpose of this study is to demonstrate long-term survival of nasopharyngeal carcinoma treated with concomitant chemotherapy and radiotherapy (CCRT) followed by adjuvant chemotherapy.

Methods and Patients: One hundred and seven patients with Stage III and IV (American Joint Committee on Cancer, AJCC, 1988) nasopharyngeal carcinoma (NPC) were treated with concomitant chemotherapy and radiotherapy (CCRT) followed by adjuvant chemotherapy between April 1990 and December 1997 in Koo Foundation Sun Yat-Sen Cancer Center, Taipei. The dose of radiation was 70 Gray (Gy) given in 35 fractions, 5 fractions per week. Two courses of chemotherapy, consisting of cisplatin and 5-fluorouracil, were delivered simultaneously with radiotherapy in Weeks 1 and 6 and two additional monthly courses were given after radiotherapy. According to the AJCC 1997 staging system, 32 patients had Stage II disease, 44 had Stage III, and 31 had Stage IV disease.

Results: With median follow-up of 44 months, the 5-year overall survival rate in all 107 patients was 84.1%, disease-free survival rate was 74.4%, and locoregional control rate was 89.8%. The 3-year overall survival for Stage II was 100%, for Stage III it was 92.8%, and for Stage IV, 69.4% (p = 0.0002). The 3-year disease-free survival for Stage II was 96.9%, for Stage III it was 87.7%, and for Stage IV it was 51.9% (p = 0.0001).

Conclusion: CCRT and adjuvant chemotherapy is effective in Taiwanese patients with advanced NPC. The prognosis of AJCC 1997 Stage II and III disease is excellent, but, for Stage IV (M0), it is relatively poor. Future strategies of therapy should focus on high-risk AJCC 1997 Stage IV (M0) cohort.     

GP、PF及TPF方案化疗联合调强适形放疗治疗鼻咽癌的临床疗效

背景与目的：诱导化疗联合放疗及辅助化疗治疗鼻咽癌的疗效目前尚未明确,本研究旨在比较GP（吉西他滨+顺铂）方案、PF（顺铂+氟尿嘧啶）方案及TPF（多西他赛+顺铂+氟尿嘧啶）方案化疗联合调强适形放疗（intensity-modulated radiotherapy,IMRT）在无远处转移鼻咽癌患者中的临床疗效。方法：本研究回顾性分析了2009年1月—2010年12月期间在复旦大学附属肿瘤医院放疗科接受诱导化疗联合IMRT及辅助化疗的134例无远处转移鼻咽癌患者。GP组（吉西他滨1 000 mg/m2,第1、8天+顺铂25 mg/m²,第1~3天）、PF组（顺铂25 mg/m²,第1~3天+氟尿嘧啶500 mg/m²,第1~5天,持续静脉滴注）及TPF组（多西他赛75 mg/m²,第1天+顺铂25 mg/m²,第1~3天+氟尿嘧啶500 mg/m²,第1~5天,持续静脉滴注）分别纳入55、20和59例患者。诱导化疗每21 d重复,2~3个疗程后行IMRT。原发灶及阳性淋巴结的大体肿瘤靶区（gross tumor volume,GTV）的处方剂量分别为（66.0~70.4）Gy/（30~32）次和66.0 Gy/（30~32）次。放疗结束28 d后行辅助化疗2~3个疗程,方案与之前接受的诱导化疗方案相同。随访并比较3组不同的诱导化疗联合放疗及辅助化疗方案的患者5年总生存期（overall survival,OS）、无病生存期（disease-free survival,DFS）及局部无复发生存期（local recurrence-free survival, LRFS）情况。结果：GP组、PF组和TPF组的5年OS率分别为91.9%、75.1%和90.8%,5年LRFS率分别为95.8%、82.3%和96%。GP组的5年OS率（P=0.041）高于PF组,TPF组的5年LRFS率高于PF组（P=0.043）。TPF组和GP组间生存曲线差异无统计学意义。结论：GP方案诱导化疗联合IMRT及辅助化疗治疗无远处转移鼻咽癌的临床疗效可能优于PF方案,尚待大样本数据验证。三药联合的TPF方案并未优于GP方案。可考虑展开Ⅲ期临床试验评价GP方案诱导化疗在无远处转移初治鼻咽癌人群中的疗效。     

TP方案诱导化疗序贯同期放化疗治疗局部晚期鼻咽癌的临床观察

目的 比较多西他赛+顺铂（TP方案）或顺铂+氟尿嘧啶（PF方案）诱导化疗3周期后联合同步放化疗治疗局部晚期鼻咽癌的疗效和安全性。方法 将局部晚期鼻咽癌患者随机分为两组：A组30例接受TP方案诱导化疗（多西他赛75 mg／m2 d1+顺铂75 mg／m2 d2）,每3周重复;B组29例接受PF方案诱导化疗（顺铂75 mg／m2 d1+氟尿嘧啶750 mg／m2 civ d1～d5）。诱导化疗结束3周后行三维适形放疗,20 Gy／次,5次／周,共6周,DT 60 Gy,并联合同步化疗（顺铂80 mg／m2,d1,每3周重复）。评价两组患者的疗效及毒副反应,并随访生存情况。结果A、B两组的有效率（RR）分别为76.7％、79.3％（P.0.05）;中位生存时间分别为39.4个月、36.0个月（P＞0.05）。A、B两组中位无进展生存时间分别为12.7个月、10.3个月,差异有统计学意义（P=0.044）。两组毒副反应主要为血液学毒性、黏膜炎等,差异无统计学意义（P＞0.05）。结论 TP方案诱导化疗联合同期放化疗可延长患者的中位无进展生存时间,且未增加不良反应,可作为局部晚期鼻咽癌治疗方案之一。     

局部晚期鼻咽癌放射治疗联合化疗的研究进展

临床Ⅲ ～Ⅳ期鼻咽癌占鼻咽癌的的大多数,根治性放疗联合化疗的综合治疗是局部晚期鼻咽癌治疗的基石,现有的证据表明,同步放化疗是中国局部晚期鼻咽癌标准治疗方法,但放化疗的最佳组合方案仍未确定。本文就这方面的研究进展作一综述。     

放疗加诱导化疗治疗中晚期鼻咽癌疗效分析

目的　探讨化疗对中晚期鼻咽癌生存率的影响。方法　将 10 0例初次治疗被确诊为中晚期鼻咽癌 (Ⅲ、Ⅳ期 )的患者随机分为两组 :单纯放疗组 (单放组 )与诱导化疗加放疗组 (放化组 ) ,每组各 5 0例。单放组鼻咽平均剂量 70Gy 7周 (6 6～ 76Gy) ,颈部平均剂量 6 5Gy 6 .5周 (5 0～ 74Gy) ;放化组在照射前行顺铂 (DDP)加氟尿嘧啶 (5 Fu)化疗 2～ 3个疗程 ,1周后行放疗 ,鼻咽平均剂量 70 .4Gy 7.5周 (6 8～ 74Gy) ,颈部平均剂量 6 6Gy 7周 (5 0～ 72Gy)。结果　单放组与放化组 1,2 ,3年生存率分别为 88.0 %和 90 .0 %、6 0 .0 %和 78.0 %、4 4 .0 %和 6 8.0 % ,两组比较差异有显著性。单放组与放化组 1,2 ,3年局控率分别为 78.0 %和 86 .0 %、4 6 .0 %和 6 8.0 %、4 0 .0 %和 6 2 .0 % ,两组比较差异有显著性。单放组与放化组Ⅰ、Ⅱ级白细胞下降发生率分别为 10 .0 %、2 8.0 %、2 .0 %和 16 .0 % ;单放组与放化组Ⅰ、Ⅱ、Ⅲ级咽黏膜反应发生率分别为 8.0 %和 4 .0 %、82 .0 %和 76 .0 %、10 .0 %和 2 0 .0 %。无因毒副作用而延迟或中断治疗者。结论　放疗前行 2～ 3疗程诱导化疗能提高中晚期鼻咽癌生存率和局控率。     

鼻咽癌放疗后口干燥症的临床分析

口干燥症是鼻咽癌放疗后最常见的后遗症之一,严重影响患者的生存质量。本研究旨在探讨鼻咽癌放疗后口干燥症的严重程度及其对日常生活的影响。     

196例鼻咽癌患者疗效分析

目的:回顾性分析鼻咽癌治疗疗效,并分析影响预后的因素。方法:对在我科接受根治性放射治疗的196例鼻咽癌患者进行随访,所有患者均接受6MV-X线照射,剂量范围64～80Gy。其中37例患者配合化疗,化疗方案均采用5-FU DDP,化疗周期2～4周期。结果:全组患者5年和10年的总生存率分别为53.10%和39.90%。单因素分析发现,性别、临床分期、T分期、N分期、原发灶剂量和下颈淋巴引流区剂量是影响预后的因素。多因素分析仅提示临床分期明显影响预后。结论:鼻咽癌放射治疗的疗效确切,临床分期、T分期、N分期是影响预后最主要的因素,提高早期患者的检出率是提高治疗鼻咽癌疗效的关键。     

鼻咽癌放疗后生育后代健康状况调查

 目的 对鼻咽癌患者康复后生育的后代健康发育情况进行调查，评价鼻咽癌治疗对后代健康发育情况的影响，指导提高鼻咽癌患者康复期的生活质量。方法 选取1969年至1997年间放疗后可能有生育能力的鼻咽癌患者，女性≤35岁，男性≤45岁，随机抽取120例发放自行设计的《鼻咽癌放疗后生育的后代健康状况调查表》，采用电话、信件、上门随访方法，对治疗后生育的后代健康发育情况进行调查。结果 有24例患者经治疗后再生育，其中男性17例，女性7例；治疗时最大年龄37岁，最小年龄16岁；治疗后最短在1年后生育，最长在6年后生育；总共生育45胎，男性19胎，女性26胎；目前最小年龄3岁，最大年龄33岁；全部体格发育正常，智力正常，学习成绩从一般～优秀。结论 鼻咽癌患者治疗后生育的后代体格发育正常，智力正常，提示健康，这与放疗防护最优化设计进步相关，使辐射伤害降到最低。     

诱导化疗对鼻咽癌调强放疗靶区和剂量分布的影响研究

目的分析诱导化疗前后鼻咽癌肿瘤体积的变化,及靶区和正常组织剂量分布的变化。方法自2009年3月至2010年8月收治12例经病理证实的初治局部晚期鼻咽癌患者,调强放疗前接受PF方案诱导化疗2周期。对患者诱导化疗前作CT模拟定位扫描后行靶区勾画和制定诱导化疗前调强放疗(IMRT)计划。2周期诱导化疗后进行第2次CT扫描,并将两次CT图像进行融合后测量肿瘤体积和制定诱导化疗后IMRT计划。采用配对t检验分析诱导化疗前后扫描肿瘤体积的变化,及靶区和正常组织剂量分布的变化。结果诱导化疗前和后原发灶GTVnx平均体积分别为(39.75±19.17)cm3和(25.65±15.11)cm3(t=4.203,P=0.001);颈淋巴结GTVnd(33.78±28.9)cm3和(15.56±14.91)cm3(z=2.94,P=0.003);原发灶+颈淋巴结GTV(73.53±31.55)cm3和(41.2±24.06)cm3(t=4.753,P=0.001);诱导化疗使肿瘤总体积减少了52.9%。66.5 Gy等剂量线所包括的体积分别为(302.0±110.3)cm3和(248.4±79.0)cm3(P=0.023),63 Gy等剂量线所包括的体积分别为(413.2±117.4)cm3和(409.1±115.1)cm3(P=0.097)。诱导化疗使T和N分期降低达33.3%和50%。结论诱导化疗前后肿瘤体积变化较大,按化疗后肿瘤勾画GTV的调强放疗能使高剂量区体积减少。     

诱导化疗加放射综合治疗局部晚期鼻咽癌的临床分析

目的：探讨诱导化疗对局部晚期鼻咽癌放疗疗效的影响,方法：96例Ⅲ、Ⅳ期鼻咽癌随机分为两组（化疗组及单放组）,每组48例,放疗采用^60Co机或直线加速器照射鼻咽及颈部,鼻咽剂量DT66－76Gy／6．5－7．5周,颈部剂量DT50－70Gy／5－7周。诱导化疗采用DDP＋5－FU方案。结果：化疗组一、三、五年生存率分别为为94．2％、72．9％、65．75;单放组分别为89．1％、56．8％、46．85,有显著性差异（P＜0．05）。化疗组一、三、五年局控率各为89．2％、71．4％、63．9％;单放组各为82．5％（50．1％、44．2％）,有显著性差异（P＜0．05）。化疗组远处转移率为为20．95,单放组为41．75,两组比较有显著性差异（P＜0．05）。结论：诱导化疗能提高局部晚期鼻咽癌放疗的局控率及生存率,降低远处转移。