新辅助化疗后放射治疗≥N_2期鼻咽癌的临床研究

• 作 者: 蔡长青 王甦 廖万清 宋维舒 王顺官 吴丹进
• 机 构: 解放军第一七七中心医院放疗科
• 出 处: 中国肿瘤临床
• 发表日期: 1999年06期
• 关键词: 新辅助化疗 N_2 颈部转移淋巴结 放射治疗 局部控制率 消退率 远处转移率 单纯放疗组 急性毒副反应 放疗方法

目的：比较≥Ｎ２期鼻咽癌新辅助化疗后放疗与单纯放疗的临床效果。方法：自１９９３年１０月～１９９５年３月，８６例≥Ｎ２期经病理证实的鼻咽癌患者被随机分为新辅助化疗组（Ａ组）和单纯放疗组（Ｂ组），每组４３例。Ａ组于放疗前用ＤＦ方案（ＤＤＰ、５ＦＵ）化疗２～３周期。两组放疗方法相同，全部病例用４ＭｅＶ光子线常规分割放疗，鼻咽部剂量６５～８０Ｇｙ／６５～８周，颈部剂量５８～７２Ｇｙ／５８～７２周。结果：Ａ组和Ｂ组鼻咽部肿瘤完全消退率分别为８８４％和９３５％，颈部转移淋巴结完全消退率分别为９０７％和９３５％，均无显著性差异（Ｐ＞００５）。两组３年生存率分别为７１８％和５６６％，Ａ组高于Ｂ组（Ｐ＜００５）。３年鼻咽部肿瘤局控率和颈部转移淋巴结控制率Ａ组均高于Ｂ组（均为Ｐ＜００１）。Ａ、Ｂ两组远处转移率分别为２０８％和３０２％，有显著性差异（Ｐ＜００５）；平均转移时间分别为１９个月和９个月，两组有显著性差异（Ｐ＜００１）。Ａ组急性毒副反应较Ｂ组重，但未影响治疗进程。结论：对≥Ｎ２期颈淋巴结转移的鼻咽癌患者放疗前化疗（新辅助化疗）能提高患者生存率和局部控制率，减少远处转移，延长出现转移的时?

Objective: To compare the clinical effects of radiotherapy and radiotherapy alone after neoadjuvant chemotherapy for ≥N2 stage nasopharyngeal carcinoma. Methods: From October 1993 to March 1995, 86 patients with pathologically confirmed NPC ≥2 were randomly divided into neoadjuvant chemotherapy (group A) and radiotherapy alone (group B), with 43 example. Group A before radiotherapy with DF program (DDP, 5  FU) chemotherapy 2 to 3 cycles. The radiotherapy method was the same in both groups. Radiotherapy was routinely performed with 4 MeV photons in all cases. The dose of nasopharyngeal was 65-80 Gy / 6.5 weeks, and the dose of cervical was 58-72 Gy / 5-8-7.2 weeks. Results: The complete regression rate of nasopharyngeal tumors in group A and group B were 884% and 935% respectively, and the complete regression rate of cervical lymph node was 907% and 935% respectively, with no significant difference (P> 005). The 3-year survival rates of the two groups were 718% and 566%, respectively, and those in group A were higher than those in group B (P <005). 3-year nasopharyngeal tumor control rate and cervical lymph node metastasis control group A were higher than the B group (both P <0  01). The distant metastasis rates of group A and group B were 208% and 302%, respectively, with significant difference (P <005). The average metastatic time was 19 and 9 months respectively, with significant difference between the two groups Sex differences (P <001). A group of acute toxicity than the B group, but did not affect the course of treatment. Conclusion: Pretreatment chemotherapy (neoadjuvant chemotherapy) can improve the survival rate and local control rate of patients with nasopharyngeal carcinoma of cervical lymph node metastasis of grade ≧ N2, reduce the distant metastasis and prolong the time of metastasis.