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目的 :探讨化疗在高危远转移鼻咽癌中的临床应用价值。方法 :1996年 3月～ 1998年 6月 ,84例鼻咽癌患者随机分为单纯放疗组 (单放组 )和放疗加化疗组 (综合组 )。每组 42例 ,单放组采用加速器 6MV -X线加9- 12MeV电子线照射 ,鼻咽中平面剂量 70～ 80Gy ,颈部根治剂量 6 5～ 75Gy ,颈部预防剂量 5 0Gy。综合组除接受上述处理外还接受顺铂 (DDP)加 5氟脲嘧啶 (5 -FU)加亚叶酸钙 (CF)化疗 4周期 ,第 1周期化疗在放疗前 1周进行 ,第 2、3、4周期化疗分别在放疗结束后 0周、4周、8周进行。结果 :3年生存率、3年局部控制率、近期肿瘤消退率综合组分别为 73.8%、6 9%、85 .7% ,单放组分别为 5 2 .4%、45 .2 %、6 6 .7% ,综合组高于单放组 ,有显著性差异 (均P <0 .0 5 )。远处转移率综合组为 2 3.8% ,单放组为 47.6 % ,以单放组为高 ,出现远处转移的平均时间综合组为 2 0 .4个月 ,单放组为 7.9个月 ,综合组出现得较迟 ,有显著性差异 (均P <0 .0 5 )。两组病例均未出现严重毒副反应。放射性脑病综合组出现 2例 ,单放组 1例 ,严重张口困难综合组 1例 ,单放组0例 ,无显著性差异 (P >0 .0 5 )。结论 :DDP +5 -FU +CF能提高高危远转移鼻咽癌患者的生存率、局控率、肿瘤近期消退率 ,能降低远处转移的发生率 ,延长远处?
Objective: To investigate the clinical value of chemotherapy in high-risk far-metastatic nasopharyngeal carcinoma. Methods: From March 1996 to June 1998, 84 patients with nasopharyngeal carcinoma were randomly divided into radiotherapy group (radiotherapy alone group) and radiotherapy plus chemotherapy group (combined group). In each group, 42 cases were treated with accelerator 6MV-X and 9-12MeV electron beam. The median dose in the nasopharynx was 70-80 Gy, the radical was 65-575 Gy, and the neck was 50 Gy. In addition to the above treatment group also received cisplatin (DDP) plus 5-fluorouracil (5 -FU) plus calcium folinate (CF) chemotherapy for 4 cycles, the first cycle of chemotherapy in the first week before radiotherapy, 2,3 , 4 cycles of chemotherapy were 0 weeks after the end of radiotherapy, 4 weeks, 8 weeks. Results: The 3-year survival rate, 3-year local control rate, and recent tumor regression rate were 73.8%, 69%, 85.7% in the combined group and 52.4%, 45.2%, and 6.2% 6 .7%, the comprehensive group was higher than the single group, there was a significant difference (all P <0. 05). The distant metastasis rate was 3.8% in the combined group and 47.6% in the radiotherapy group. The mean time to distant metastasis in the radiotherapy group was 20.4 months, in the radiotherapy group was 7.9 months, The combination group appeared later, with significant difference (all P <0.05). Two groups of patients did not appear serious side effects. There were 2 cases of radiotherapy combined with radiotherapy, 1 case of radiotherapy alone, 1 case of severe laryngopharyngeal complex, and 0 case of radiotherapy alone. There was no significant difference (P> 0.05). Conclusion: DDP +5 -FU + CF can improve the survival rate, local control rate and tumor regression rate in high-risk far-metastatic NPC patients, and can reduce the incidence of distant metastasis and prolong the distance?