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。

Clinical observation of TP induction chemotherapy combined with concurrent chemoradiotherapy in un-treated locally advanced nasopharyngeal carcinoma

Objective To compare the efficacy and side effects of untreated locally advanced nasopharyngeal carcinoma by TP induction chemotherapy regimen or PF regimen. Methods The locally advanced nasopharyngeal carcinoma patients were randomly divided into group A（n=30， TP regimen： docetaxel 75 mg／m2 d1，cisplatin 75 mg／m2 d2， 21 days as a cycle） and group B（n=29，PF regimen： cisplatin 75 mg／m2 d1， fluorouracil 750 mg／m2 civ d1 d5， 21 days as a cycle）. After induction chemotherapy for three cycles， all patients underwent concurrent chemoradiotherapy. Chemotherapy was taken as follow： cisplatin 80 mg／m2 d1， 21 days as a cycle. The radiotherapy dosage was 2.0 Gy per fraction，5 fractions a week，for 6 weeks，and total dosage was 60 Gy. The efficacy was evaluated and the survival was followed-up. Results There were no significant differences in the objective response rate （76.7％ vs. 79.3％， P＞0.05） and overall survival （39.4 months vs. 36.0 months， P＞0.05） between the two groups. But the progression free survival of group A was longer than group B （12.7 months vs.10.3 months， P=0.044）. The main side effects in two groups were hematologic toxicities and mucosities with no statistical difference（P＞0.05）. Conclusion TP and PF induction chemotherapy combined with concurrent chemoradiotherapy had equal clinical efficacy in the treatment of locally advanced nasopharyngeal carcinoma. TP induction chemotherapy can be a viable alternative treatment of nasopharyngeal carcinoma.