TPF方案诱导化疗联合同步放化疗治疗局部晚期鼻咽癌的临床观察

目的观察比较TPF方案诱导化疗联合同步放化疗与同步放化疗治疗局部晚期鼻咽癌的疗效及毒副反应。方法57例局部晚期鼻咽癌患者随机分为诱导化疗加同步放化疗组（试验组，27例）和同步放化疗组（对照组，30例）。试验组TPF方案（多西他赛75mg/m^2，dl，顺铂75mg／m^2，分4～5d给药，氟尿嘧啶500mg/m^2，d1～5，q3W×2）诱导化疗＋同步放化疗（IMRT加同步化疗：顺铂40mg（m^2·周）]。对照组同步放化疗（IMRT加同步化疗：顺铂40mg／（m^2·周）]。结果治疗结束3个月鼻咽病灶试验组CR率81．48％，对照组70％（P〉0．05），2年局部控制率试验组96％，对照组92．3％（P〉0．05），2年无远处转移生存率试验组92％，对照组88．5％（P〉0．05）。试验组Ⅲ一Ⅳ级白细胞减少与胃肠道反应的发生率较对照组高，差异有统计学意义（P〈0．05）。结论TPF方案诱导化疗联合同步放化疗治疗局部晚期鼻咽癌毒性反应稍高于同步放化疗组，在提高生产率方面较同步放化疗组并未取得明显的优势，有待于进一步临床研究。

Study of TPF neoadjuvant chemotherapy followed by concurrent radiochemotherapy in treatment of local advanced nasopharyngeal carcinoma

Objective To investigate and compare the effect and toxicity of TPF neoadjuvant chemotherapy followed by concurrent chemoradiotherapy and concurrent chemoradiotberapy in the treatment for locally advanced nasopharyngeal carcinoma（NPC）. Methods Fifty -seven patients with locally advanced NPC were randomly divided into two groups. The experiment group（n =27）was firstly treated with2 cycles of neoadjuvant chemotherapy. Neoadjuvant chemotherapy consisting of docetaxel （ TXT,75 mg/m2, day 1 ） , cisplatin （ DDP,75mg/m2, given in four or five days） , and fluorouracil （ 5 - FU ,500mg/m2, day 1 -5 ）. After that intensity modulated radiotherapy（IMRT） combined with chemotherapy with DDP 40mg/mZ/w was administered. The control group received IMRT combined with concurrent chemotherapy with DDP 40mg/m2/w. Results The CR rate for primary disease of the experiment group and control group was 81.48% and 70% , respectively （P 〉 0. 05 ）. The two -year local control rate in experiment group was 96% , while 92% in the control group（P 〉 0. 05 ）. The two -year distant metastasis free survival rate in Experiment Group and in control group was 92% and 88.5% respectively（P 〉 0. 05）. The incidence of grade Ill and IV leukopenia and gastrointestinal reactions in experiment group was significantly higher than that in control group （ P 〈 0. 05 ）. Conclusion The randomized study failed to demonstrate any significant survival benefit with the addition of neoadjuvant chemotherapy to concurrent chemo- radiotherapy. The rate of toxic reaction of neoadjuvant chemotherapy followed by concurrent radiochemotherapy group is higher than that in concurrent chemoradiotherapy group.