调强放疗结合诱导化疗或同期加辅助化疗治疗局部晚期鼻咽癌的疗效比较

目的:比较诱导化疗加调强放疗和同期放化疗加辅助化疗治疗局部晚期鼻咽癌的疗效。方法:收集2004年1 月至2008年12月中山大学肿瘤医院收治的经病理证实的局部晚期鼻咽癌240 例，其中采用顺铂+ 5-FU 诱导化疗加调强放疗（诱导组）117 例，采用顺铂、调强放疗同期放化疗加顺铂+ 5-FU 辅助化疗（同期组）123 例。应用Kaplan-Meier 和Log-rank 法计算和比较两组患者的生存率。结果:诱导组和同期组的5 年总生存率、无瘤生存率、无转移生存率、无鼻咽复发生存率和无颈部复发生存率分别为78.0% 和78.7% 、68.9% 和67.5% 、79.0% 和77.0% 、91.6% 和91.0% 、95.3% 和93.7% ，两组比较差异无统计学意义（P>0.05）。 同期组Ⅲ、Ⅳ级恶心呕吐和白细胞减少的发生率明显高于诱导组。多因素分析结果显示N 分期和年龄是影响局部晚期鼻咽癌患者总生存的预后独立因素。结论:诱导化疗加调强放疗治疗局部晚期鼻咽癌的疗效达到同期放化疗加辅助化疗的水平，远处转移是局部晚期鼻咽癌治疗失败的主要原因。 

Comparison of efficacy of induction chemotherapy plus intensi-ty-modulated radiotherapy and concurrent chemo-radiotherapy plus adjuvant chemotherapy for patients with loco-regionally ad-vanced nasopharyngeal carcinoma

Objective: To compare the efficacy of induction chemotherapy (IC) plus intensity-modulated radiotherapy (IMRT) with that of concurrent chemo-radiotherapy (CCRT) plus adjuvant chemotherapy (AC) for patients with loco-regionally advanced naso-pharyngeal carcinoma (NPC).Methods:Data of240 patients with loco-regionally advanced NPC were reviewed. These patients were admitted to the Sun Yat-sen University Cancer Center between January 2004and December 2008. Among the 240 patients, 117 under-went the IC+IMRT and123 were treated with the CCRT+AC. The IC+IMRT group received a regimen including cisplatin and 5-fluoro -uracil ( 5-FU). The CCRT+AC group received cisplatin concurrently with radiotherapy and subsequently received adjuvant cisplatin and 5-FU. The survival rates of the patients were assessed by Kaplan-Meier analysis, and the survival curves were compared by Log-rank test. Multivariate analysis was conducted using Cox proportional hazard regression model. Results: The 5-year overall survival (OS), disease-free survival, distant metastasis-free survival, local relapse-free survival, and the nodal relapse-free survival were78.0% versus 78.7% ,68.9% versus 67.5% ,79.0% versus 77.0% ,91.6% versus 91.0% , and 95.3% versus 93.7% in the IC + IMRT and CCRT + AC groups, respectively. The survival between the two groups exhibited no significant differences. Higher rates of Grades 3 to 4 nau-sea-vomiting ( 8.1% vs.1.7%,P=0.023) and leukopenia ( 9.7% vs.0.9%,P=0.006) were observed in the CCRT+AC group. Multivariate analysis revealed that N stage and age were significant prognostic factors for the OS of the patients with loco-regionally advanced NPC. Conclusion:The treatment outcomes of IC+IMRT and CCRT+AC were similar. Distant metastasis remained as the predominant mode of treatment failure.