放射治疗同期联合每周顺铂治疗局部晚期鼻咽癌的临床研究

目的评价放射治疗同期联合每周顺铂治疗局部晚期鼻咽癌（Locally Advanced Nasopharyngeal Carcinoma，LANPC）的急性和晚期反应以及疗效和预后分析。方法2001年1月-2008年12月，共有78例局部晚期鼻咽癌患者（UICC分期Ⅲ，Ⅳa，Ⅳb）入组，所有病人均接受常规放射治疗，并于放射治疗的第一周起静脉滴注顺铂30mg／m2，每周一次，连续5—7周。结果78例患者均可评价毒副反应及客观疗效，所有病人完成了计划剂量的放射治疗，96％的病人完成了顺铂的治疗，少见严重的毒副反应。中位随访83个月后，全组病人死亡27例，2、4年总生存率（OS）为96％，64．1％；2年无复发生存率（RFS）及无转移生存率（MFS）均为92％；2、4年无进展生存率（PFS）为92％、50％。单因素分析得出生存率与患者性别、N分期、临床分期有关，放疗期间提高顺铂总量以及放疗后是否辅助化疗不影响患者生存率。结论每周30mg／m2顺铂联合放射治疗能使局部晚期鼻咽癌病人达到较高的局部控制率和生存率，同时急性放射反应和晚期放射损伤基本在患者可接受范围内。提高顺铂使用的总剂量及放疗后辅助化疗并不能提高生存率。

Clinical Study on Standard Radiotherapy Concurrently with Weekly Cisplatin for Treatment of Locally Advanced Nasopharyngeal Carcinoma

Objective To observe the acute and late toxicities of radiotherapy concurrently with weekly cispl- atin in patients with locally advanced nasopharyngeal cancer（LANPC）,and analyze the efficacy and variables prog- nostic of LANPC.Methods From January 2001 to December 2008,78 patients with LANPC（Ⅲ ,Ⅳa, Ⅳb） were en- rolled.Cisplatin 30mg/m2 was administered weekly for 5 - 7 cycles from the first week of radiotherapy.The overall response and survival rates were calculated,and the influence of patient-,tumor-,and treatment-related variables on outcome were determined.Results All patients were eligible for toxicity and response analysis. 100% of the pa- tients completed the planned radiotherapy, while full cycles of cisplatin being given to 96% of the patients,and rare of high-grade toxicity was observed.After a median follow-up of 83 months,the 2-year,4-year overall survival（OS） were 96% and 64.1%.The 2-year relapse-free survival（RFS） and metastasis-free survival（MFS） were 92%.The 2-year,4-year progress-free survival（PFS） were 92% and 50%.On simple analysis,the variable of sex,N stage and clinical stage influenced overall survival.Conclusion Radiotherapy concurrently with weekly cisplatin 30mg/m2 is well tolerable,while good OS rate and PFS rate are observed in patients with LANPC.The cisplatin doses over 180mg/m2 during radiotherapy and adjuvant chemotherapy have no correlation with the OS rate.