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目的 探讨在鼻咽癌治疗中采用不同化疗方案配合常规放射治疗对肿瘤局部控制及远期生存的影响。方法 30 0例病理证实的鼻咽癌病例随机分为单纯放射治疗组 114例 ,放射治疗 +新辅助化疗组 93例 ,放射治疗 +同步化疗组 93例。常规放射治疗 :鼻咽原发灶DT70Gy ,颈部预防照射DT5 0Gy,转移灶DT6 5～ 70Gy。新辅助化疗 :氟尿嘧啶 10 0 0mg/d ,3次 /周 ,顺铂 10 0mg/周 ,交替各用 2周。同步化疗 :顺铂 2 0mg/d ,2次 /周 ,氟尿嘧啶 5 0 0mg/d ,2次 /周 ,交替各用 3周。结果 5年总生存率 (OS)为 5 7.1% ,5年无瘤生存率 (DFS)为 5 2 .9% ,5年无远地转移生存率 (DMF)为 6 1.0 % ,5年局部区域无复发生存率 (LRF)为 83.3 % ;各治疗组间 5年OS、DFS、DMF和LRF差异无显著性意义 (χ2 值分别为 2 .94、0 .85、1.2 3、0 .37,P值分别为 0 .2 3、0 .6 5、0 .5 4、0 .83)。治疗后的远期并发症 (张口困难、放射性脑病 )发生率各组间差异无显著性意义 (χ2 值分别为 0 .2 79、0 .35 5 ,P值分别为 0 .870、0 .837)。影响预后的多因素分析结果显示仅与N分期有关 ,与治疗方法无关。结论 放射治疗 +新辅助化疗或同步化疗均未能提高生存率和局部控制率 ,放射治疗配合化疗的适应证、化疗方法有待进一步探讨
Objective To investigate the effects of different chemotherapy and routine radiotherapy on tumor local control and long-term survival in the treatment of nasopharyngeal carcinoma. Methods One hundred and thirty cases of nasopharyngeal carcinoma confirmed by pathology were randomly divided into radiotherapy alone group (n = 114), radiotherapy plus neoadjuvant chemotherapy group (n = 93) and radiation therapy plus concurrent chemotherapy group (n = 93). Conventional radiotherapy: primary tumor of the nasopharynx DT70Gy, neck prevention irradiation DT5 0Gy, metastasis DT6 5 ~ 70Gy. Neoadjuvant chemotherapy: fluorouracil 10 0mg / d, 3 times / week, cisplatin 10mg / week, alternately for 2 weeks. Synchronous chemotherapy: cisplatin 20mg / d, 2 times / week, fluorouracil 500mg / d, 2 times / week, alternately for 3 weeks. Results The 5-year overall survival (OS) was 51.1%, the 5-year disease-free survival (DFS) was 52.9%, the 5-year distant metastasis-free survival No recurrence-free survival (LRF) was 83.3%. There was no significant difference in 5-year OS, DFS, DMF and LRF between the treatment groups (χ2 = 2.94,0.85,1.23,0.37, P Values were 0 .2 3,0 .6 5,0 .5 4,0 .83). There was no significant difference in the incidence of long-term complications after treatment (mouth opening difficulties, radiation encephalopathy) between groups (χ2 = 0.79, 0.355, P = 0.70, ). Multivariate analysis of prognostic factors showed only N staging, not related to treatment. Conclusions Both radiotherapy and neoadjuvant chemotherapy or concurrent chemotherapy failed to improve the survival rate and local control rate. The radiotherapy and chemotherapy indications and chemotherapy need to be further explored