化放疗与单放疗治疗Ⅲ，Ⅳa期鼻咽癌远期疗效的比较
作者：陆小军，雷风，吴新光，叶亦菁，刘玉猛，何伟基，周锡刚，王得坤【关键词】 鼻咽肿瘤/药物疗法,放射疗法；治疗结果
Comparison of the longterm effects of chemoradiotherapy and radiotherapy alone for patients with stage Ⅲ, Ⅳa nasopharyngeal carcinoma
【Abstract】 AIM: To study and compare the longterm effects of chemoradiotherapy and radiotherapy alone in the treatment of nasopharyngeal carcinoma (NPC). METHODS: A total of 180 patients with stage Ⅲ or Ⅳa NPC diagnosed pathologically were randomly divided into chemotherapy plus radiotherapy group (CT/RT group) and radiotherapy alone group (RT group). Cisplatinbased induction chemotherapy was performed in CT/RT group for 2 cycle (DFP, TFP, in 47 cases; PF, PFB, EFP in 43 cases) and radiotherapy was started in 1 week after the last chemotherapy. The methods of radiation were the same in both groups. RESULTS: The distant metastasis free survival (DMFS) rates in 3 and 5 years were 88.9%, 82.2% and the relapse free survival (RFS) rates in 3 and 5 years were 75.6%, 67.8% in CT/RT group; the 3, 5year DMFS rates were 72.2%, 65.6% and the 3, 5year RFS rates were 71.1%, 64.4% in RT group; there was no differences of statistical significance in 3, 5year RFS rates (P=0.089, P=0.076), but there was statistically significant difference in 3, 5year DMFS rates (P=0.029, P=0.024). The therapeutic effect of induction chemotherapy project including paclitaxel such as DFP, TFP was more excellent than classical chemotherapy projects such as FP, FBP, EFP (3, 5year DMFS: P=0.019, P=0.022). The acute oral mucositis of Ⅲ, Ⅳ degree and leucopenia in the former groups were much more severe than those in the latter groups (51.1% vs 30.2%, P=0.018; 34.0% vs 14.0%, P=0.07). But these adverse eactions can be tolerable by using GCSF. There were no cases or death of allergy correlated to treatment. No patients need to decrease the dose of chemotherapy or radiation or to terminate the treatment, or to delay the late radiotherapy. CONCLUSION: The chemoradiotherapy can decrease significantly the rate of distant metastasis as compared with radiotherapy alone, but there is no statistically significant difference in RFS rate. The therapeutic effect of induction chemotherapy project including paclitaxel such as DFP, TFP is more excellent than classical chemotherapy projects such as FP, FBP, EFP, but acute oral mucositis (Grade Ⅲ of Ⅳ) and leucopenia in the former groups were much more severe than those in the latter grou
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