NP方案联合局部放疗治疗鼻咽癌骨转移

目的：观察NP方案联合局部放疗治疗鼻咽癌骨转移的疗效。方法：60例鼻咽癌骨转移患者随机分为单放组和放化综合组各30例，单放组针对骨转移疼痛最剧烈处照射，行局部小野照射或适当扩大照射野。对于多发性骨转移患者，则着重选择2—3个疼痛最明显的部位放疗，总剂量30—46Gy／3—4．5周。放化疗综合组化疗采用NP方案，长春瑞滨（NVB）25mg／m^2，d1、d3，顺铂（PDD）20mg／m^2，d1-d4，21天至28天为1个周期。在放疗前行第2周期化疗，在化疗间歇期开始放疗，放疗方法与单纯放疗组相同，所有患者均行4周期化疗。结果：近期疗效：单放组和综合治疗组有效率（CR＋PR）分别为83．3％（25／30）和80．0％（24／30），两组疗效无显著性差异（P〉0．05），但是CR综合组（26．7％）高于放疗组（13．3％）。治疗后中位生存时间（MST）：单放组为5．3个月，综合组为7．6个月；1年生存率：单放组10．0％（3／30），综合组23．3％（7／30），差异有显著性（P〈0．05）。疼痛改善情况：单放组和综合治疗组疼痛缓解有效率分别为96．7％（29／30）和93．3％（28／30），差异无显著性（P〉0．05）。结论：NP方案联合化疗加局部小野姑息性放疗对鼻咽癌骨转移是较好的治疗方法。

Effect of NP scheme chemotherapy combined with local radiotherapy to Treat bone metastasis in nasopharyngeal carcinoma

Objective：To evaluate the effect of combination with NP scheme chemotherapy and local radiotherapy to treat bone metastasis in nasopharyngeal carcinoma. Methods ： Sixty patients with bone metastasis of nasopharyngeal carcinoma were devided into 2 groups randomly ： local radiotherapy group （ 30cases ）, radio - chemotherapy group （ 30 cases）. The local radiotherapy group were treated with local small field,or extensive field radiotherapy at the most painful locations. The total irradiation dose of radiotherapy were 30 - 40Gy/3 - 4.5 weeks. The radio - chemotherapy group were treated with radiotherapy, same as the local radiotherapy group, vinorelbine （25mg/m2 , d1 , d8 ） plus cisplatin（20mg/m^2 , d1 -d4 ） ,21 -28 days as one cycle. Results：In the local radiotherapy group and radio -chemotherapy group overall response rate （ CR ＋ PR） were 83.3 % and 80.0%, respectively （P 〉 0.05 ）. But there were more cases of CR in radio - chemotherapy group （26.7%） than in local radiotherapy group （ 13.3% ） , 1 year survival rates were 10.0% and 23.3% （P 〈 0.05 ）. The level of pain relief：effective response rates were 96.7% and 93.3 % , respectively （ P 〉 0.05 ）. Conclusion： NP scheme chemotherapy combined with local radiotherapy is a better way to treat the bone metastasis in nasopharyngeal carcinoma.