摘要
背景与目的:鼻咽癌是中国南方地区常见的恶性肿瘤,大多数鼻咽癌的病理类型是低分化鳞癌,对放疗和化疗均敏感。鼻咽癌主要的治疗手段是放疗。对早期鼻咽癌患者有效。然而,局部晚期鼻咽癌单纯放疗常有局部复发和远处转移,5年生存率只有40%左右。为了减少局部复发和远处转移的发生,联合放、化疗十分必要。为此,本研究探讨大剂量诱导化疗+放疗治疗局部晚期鼻咽癌的疗效。方法:对1992年5月—1998年8月确诊为局部晚期的鼻咽癌患者113例作为诱导化疗+放疗组(CT/RT组),放疗前接受化疗。化疗方案:卡铂(Carboplan-tin)300mg/m2,d1静脉点滴,5-氟尿嘧啶(5-Fluorinracil,5-FU)1000mg/m2,d1～d5静脉点滴,化疗后休息2周,共3个疗程。在同期的鼻咽癌患者中,按照92福州分期标准,选择113例性别、年龄、病理类型和TNM分期与CT/RT患者相同或近似患者进行配对,作为单纯放疗组(RT组)。结果:化疗的近期疗效:鼻咽部原发灶和颈部转移淋巴结的总缓解率分别为53.9%(61/113)和72.7%(56/77)。远期疗效CT/RT组与RT组比较,Ⅲ期患者5年总的生存率分别为76.3%和47.3%(χ2=9.88507,P<0.01),Ⅳ期患者分别为32.4%和16.2%(χ2=5.10345,P<0.05),5年无瘤生存率Ⅲ期患者分别为57%和30.4%(χ2=8.648,P<0.01)。Ⅳ期患者分别为29%和16.2%(χ2=8.6218,P<0.01)。5年无远处转移生存率,Ⅲ期患者分别为64.4%和37.8%(χ2=9.50165,P<0.01),Ⅳ期患者分别为37.8%和16.2%,差异有显著性(χ2=4.3831,P<0.05)。结论:诱导化疗应用于局部晚期鼻咽癌,能够提高患者的生存率,值得推广应用。
Background and purpose：Nasopharyngeal carcinoma（NPC）is the most common cancer in southern China.Nearly 95% of NPC are poorly differentiated squamous cell carcinoma which are sensitive to radiotherapy and chemotherapy.The mainstay treatment option of NPC is radiotherapy,especially for early stage NPC.However,local recurrence with /or without distant metastasis is still the major concern after radiotherapy alone for locally advanced NPC.The consequent five year survival rate is as low as around 40%.In order to decrease the locoregional failure and reduce the distant metastasis rate,it is necessary to combine chemotherapy with radiotherapy.Our study is to explore the effect of treatment in patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy plus neoadjuvant chemotherapy.Methods：From May 1992 to August 1998,a total of 113 patients diagnosed as locally advanced NPC were eligible as neoadjuvant chemotherapy combined with radiation therapy（CT/RT）group,neoadjuvant chemotherapy regimens consisted of carboplatin（300 mg/m^2,d1 iv drip）,5-Fluorinracil（1 000 mg/m^2,d1-d5 iv drip）interval 2-weeks after the chemotherapy;then enter into the second course.The total chemotherapy period was 3 courses.Another 113 patients according to the standard of Fuzhou staging to match cohort with the patients at same age,sex,histology and T,N,classification in CT/RT group were eligible in the radiation therapy（RT）alone group.Results：For short-term effects of chemotherapy,the overall response rates of primary tumor and lymph node were 53.9%（61/113）and 72.7%（56/77）respectively.For long-term effects：the 5-yeas overall survival rates in CT/RT group and RT group for stage Ⅲ disease were 76.3% and 47.3%,respectively（χ^2=9.88507,P〈0.01）,compared to 32.4% and 16.2% for stage Ⅳ disease（χ^2=5.01345,P〈0.05）.The 5-years disease free survival in CT/RT group and RT group for stage Ⅲ disease were 57% and 30.4%（χ^2=8.648,P〈0.01）,respectively compared to 29% and 16.2%
出处
《中国癌症杂志》
CAS
CSCD
2008年第5期380-384,共5页
China Oncology
关键词
鼻咽癌
诱导化疗
放疗
晚期
nasopharyngeal carcinoma
neodjuvant chemotherapy
radiotherapy
advanced
