放化疗联合治疗局部晚期鼻咽癌的临床研究

目的：探讨放化疗交替疗治疗局部晚期鼻咽癌的临床疗效。方法：回顾性分析106例局部晚期鼻咽癌患者临床资料。单纯放疗15例；91例接受PF方案为基础的诱导化疗和（或）辅助化疗，其中诱导化疗加放疗加辅助化疗36例，诱导化疗加放疗25例，放疗加辅助化疗30例。诱导化疗1～2周期，辅助化疗3～6周期。放疗于诱导化疗结束后第1天进行，辅助化疗在放疗结束后1周开始进行。鼻咽原发灶采用60Co，常规分割照射68-74Gy，颈部根治量60～70Gy，颈部预防量48～50Gy，每组均完成根治量放疗。结果：中位随访时间51个月，58例患者死亡，全组总生存率为45．3％。单纯放疗、诱导化疗加放疗加辅助化疗、诱导化疗加放疗、放疔加辅助化疗的5年总生存率分别为33％、63％、60％、50％，无瘤生存率分别为13％、56％、48％、40％，无局部复发率分别为13％、53％、48％、50％，无远处转移率分别为6％、50％、44％、47％，均差异有统计学意义（P〈0．05）。各组发生复发、转移的中位时间分别为22、29、28、25个月；10、19、15、12个月，均差异无统计学意义（P〉0．05）。诱导化疗加放疗加辅助化疗组急性毒性反应较其他组重，但未影响治疗进程，患者均可耐受。结论：诱导化疗和辅助化疗联合尽早开始的放疗治疗局部晚期鼻咽癌疗效较好，不良反应轻，适合局部晚期鼻咽癌患者的综合治疗。

Clinical efficacy of alternating chemo-radiotherapy for locally advanced nasopharyngeal carcinoma

Objective：The purpose of this study is to investigate the effective of alternating Chemo-radiotherapy for locally Advanced Nasopharyngeal Carcinoma. Method： Retrospective analysis 106 cases of patients with locally advanced nasopharyngeal carcinoma between November 2005 and March 2007. All patients received cisplatinbased chemotherapy but 15 patients received radiotherapy（RT） alone. Inducing chemotherapy（IC） ＋ RT ＋ adjuvant chemotherapy（AC） regimen in 36 patients, IC＋RT regimen was delivered in 25 patients and AC＋RT regimen in 30 patients. 61 patients received 1 to 2 cycles of inducing chemotherapy and 66 patients received 3 to 6 cycles of adjuvant chemotherapy after radiotherapy. Chemotherapy started on the first day after the end of the induction chemotherapy, adjuvant chemotherapy begun after radiotherapy for a week. All patients were treated by radiotherapy using 60Co r-ray, the nasophyarynx primary site was given a total does of 68 -74 Gy. The lymph nodes of the neck was given 60 to 70 Gy. The prophylactic irradiation does of the neck was 48-50 Gy. Reseult：The median follow up time was 51 months. A total of 58 patients died, the overall survival rate was 45 % in whole groups. The 5-year overall survival rates were 33% .63% ,60% and 50% in RT, IC＋RT＋AC, IC＋RT and RT＋AC group, respectively. The 5-year disease-free survival rates were 13%, 56 %, 48 % and 40% in RT, IC ＋ RT ＋ AC, IC ＋ RT and RT ＋AC group,respectively. The 5-year relapse-free survival rates were 13% ,53% ,48% and 50% in RT, IC＋RT＋AC, IC ＋RT and RT＋AC group, respectively. The 5-year metastasis-free survival rates were 6 %. 50%.44% and 47% in RT, IC＋RT ＋ AC, IC＋RT and RT ＋ AC group, respectively. There was significant difference in all groups（P 〈 0. 05）. The median time to relapses were 22 months, 29 months, 28 months and 25months in RT, IC＋RT＋AC, IC＋RT and RT ＋ AC group, respectively. The median time to first distant metastasis were 10 months, 19 months, 15months and 12 months in RT, IC ＋RT ＋ AC, IC ＋RT and RT ＋AC group, respectively. There was no significant difference in all groups（P〉0.05）. IC ＋RT ＋ AC group had heavier acute toxicity effects than other groups, but it did not affect the treatment process, all patients could be tolerated.Conclusion：This retrospective study has demonstrated that alternating Chemo-radiotherapy and early radiotherapy not only can improve the survival rate for locally Advanced Nasopharyngeal Carcinoma , but also have slight toxicities and side reaction ,all patients may tolerated.