奈达铂联合氟尿嘧啶诱导化疗加同步放化疗在局部晚期鼻咽癌的临床应用

目的 观察奈达铂联合氟尿嘧啶诱导化疗加同步放化疗治疗局部晚期鼻咽癌的疗效及安全性。方法70例局部晚期鼻咽癌患者随机分为试验组（35例）和对照组（35例）。试验组接受诱导化疗2个周期，化疗方案为奈达铂80mg／m²静滴，d1；氟尿嘧啶500 mg／m²静滴，d1～d5。21天为1周期。诱导化疗结束14天后进行同步放化疗，同步化疗采用奈达铂80mg／m²静滴，d1、d22、d43；放疗采用常规放疗，鼻咽部原发灶剂量为68～74 Gy，每次均为2 Gy，每周5次。对照组接受顺铂同步放化疗，同步化疗采用顺铂100 mg／m²静滴，d1、d22、d43；放疗方法同试验组。同步放化疗结束21天后进行辅助化疗2个周期，化疗方案为：顺铂80mg／m²静滴，d1；氟尿嘧啶500 mg／m2静滴，d1～d5。21天为1周期。结果 试验组35例患者中，1例因经济原因退出了研究，34例可评价疗效，对照组35例患者均可评价疗效。治疗结束3个月后试验组CR 30例，PR 4例，有效率达100.0％（完全缓解率为88.2％）；对照组CR 31例，PR 4例，有效率达100.0％（完全缓解率为88.6％），两组比较差异无统计学意义（P＞0.05）。试验组、对照组2年生存率分别为94.1％和91.4％，两者比较差异无统计学意义（P＞0.05）。在诱导化疗期间，试验组的血液学不良反应主要为白细胞减少，发生率为70.6％，与对照组辅助化疗期间白细胞减少相比无明显差异。对照组在辅助化疗期间，恶心、呕吐的发生率要明显高于试验组在诱导化疗期间的发生率（P＜0.01）。在同步放化疗期间，试验组、对照组血小板减少的发生率分别为52.9％、14.3％，差异有统计学意义（P＜0.01）；对照组恶心、呕吐的发生率则高于试验组（P＜0.01）；两组患者口腔黏膜炎、放射性皮炎的发生率均达1000％。两组患者均无治疗相关性死亡。结论 奈达铂联合氟尿嘧啶诱导化疗加同步放化疗治疗局部晚期鼻咽癌的近期疗效较好，不良反应可以耐受，远期疗效有待进一步观察。

The application of induction chemotherapy with nedaplatin combined 5-fluorouracil plus concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma

Objective To evaluate the efficacy and toxicity of nedaplatin and 5-fiuorouracil induction chemotherapy plus con- current chemoradiotherapy（CCRT） in the treatment of locally advanced nasopharyngeal carcinoma. Methods Total seventy patients with locally advanced nasopharyngeal carcinoma were randomized into the trial group （n = 35 ）and the control group（ n = 35 ）. The trial group treated with 2 cycles of induction chemotherapy with nedaplatin （ 80 mg/m2 iv, dI ） and 5-fluorouracil （500 mg/m2 iv, dl-d5 ） followed by 3 cycles of nedaplatin （80 mg/m2 iv, d1, d22 and d43 ） and radiotherapy. The control group treated with 3 cycles of cisplatin （ 100 mg/m2 d1, d22 and d43 ） and radiotherapy followed by 2 cycles adjuvant chemotherapy with cisplatin （80mg/m2 iv, d1 ） and 5-flu- orouracil （500mg/m2 iv, d1-d5 ）. For two groups, the same radiation technique was given with conventional radiotherapy; nasopharyn- geal lesions were given a total amount of 68-74Gy, 2Gy/f, 5 fractions weekly. Results Thirty-four patients in the trial group and thir- ty-five patients in control group were evaluable for treatment response. The overall response rates （ CR ＋ PR） were 100. 0% （ CR in 88.2% ） and 100.0% （CR in 88.6% ） ,respectively in the trial group and in the control group. There was no significant difference（P 〉0. 05） between two groups. The 2-year survival rate were 94. 1% and 91.4% in two groups （P 〉0. 05）. There was a high rate of neutropenia （70. 6% ） during induction chemotherapy in the trial group. No significant differences in neutropenia were observed between the trial group during induction chemotherapy and the control group durning adjuvant chemotherapy （P 〉 0. 05 ）. The rates of nausea and vomiting in the control group durning adjuvant chemotherapy were higher significantly than those in the trial group during induction chemotherapy（ P 〈 0. 01 ）. More thrombocytopenia occurred in the trial group than in the control group（52. 9% vs. 14. 3% , P 〈0. 01 ）durning CCRT, whereas more patients in the control group suffered from nausea and vomiting than in the trial group （P 〈 0. 01 ）. Mueositis and skin desquamation occurred in 100. 0% of patients in two groups durning CCRT. There were no treatment-related deaths during this study. Conclusion Nedaplatin and 5-fluorouracil induction chemotharapy plus concurrent ehemoradiotherapy is effective and tolerable in the treatment of locally advanced nasopharyngeal carcinoma. Long-term therapeutic effects of this treatment need further observation.