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目的 观察不同新辅助化疗方案联合放疗在局部晚期鼻咽癌的疗效及毒副反应。评价含HD DDP方案的临床可行性。方法 10 0例局部晚期鼻咽癌患者随机分为单纯放射治疗组 46例 (A组 ) ,低剂量新辅助化疗组 2 8例 (B组 ) ,含HD DDP新辅助化疗组 2 6例 (C组 )。化疗方案 :B组DDP总量 10 0～ 12 0mg/ 3～ 5天 ,5 FU 5 0 0～ 75 0mg/天 ,共 5天 ;C组DDP 10 0～ 13 0mg/天 ,第一天用 ,同时水化利尿 2天 ,5 FU剂量同B组 ,B、C组还分别加用ADM、PYM、VCR、MTX、Me CCNU其中之一 ,2 1天为一周期 ,共用 2～ 3周期 ,化疗后 10～ 14天放疗。常规放射治疗 :鼻咽原发灶DT66～80Gy/ 6.5～ 8周 ,颈部转移灶DT60～ 70Gy/ 6～ 7周 ,颈部预防量DT5 0Gy。 结果 所有病例如期完成治疗。放疗 40Gy时 ,颈部转移灶消退率综合组高于单纯放疗组 (C、B、A组分别为 73 .0 7%、64 .2 8%、5 4.3 5 % )。结束时、结束 1～ 2个月后 ,综合组尤其HD DDP组颈部转移灶完全缓解率明显高于单纯放疗组 (C、B、A组分别为 10 0 %、92 .86%、82 .61% )。鼻咽原发灶缓解率亦有提高 (C、B、A组分别为 88.46%、78.5 7%、68.5 7% )。毒性反应主要表现是综合组较单纯放疗组更高的胃肠道反应及 1～ 3级骨髓抑制和脱发 ,B、C组无明显差别 ,无一例肾功能不
Objective To observe the efficacy and side effects of different neoadjuvant chemotherapy regimens combined with radiotherapy in locally advanced nasopharyngeal carcinoma. To evaluate the clinical feasibility of HDDP-containing regimens. Methods One hundred and ten patients with locally advanced nasopharyngeal carcinoma were randomly divided into radiotherapy alone group (n = 46), low dose neoadjuvant chemotherapy group (n = 28), and HD DDP neoadjuvant chemotherapy group (n = group). Chemotherapy regimen: The total dose of DDP in group B was 100 ~ 120mg / 3 ~ 5 days, 5 FU 500 ~ 75 0mg / day for 5 days. The DDP in group C was 10 ~ 130mg / day, At the same time diuretic hydration for 2 days, 5 FU dose with B, B, C group were also added ADM, PYM, VCR, MTX, Me CCNU one of 21 days for a cycle, shared 2 to 3 cycles of chemotherapy After 10 to 14 days of radiotherapy. Conventional radiotherapy: the primary nasopharynx DT66 ~ 80Gy / 6.5 ~ 8 weeks, neck metastases DT60 ~ 70Gy / 6 ~ 7 weeks, the amount of prevention of neck DT5 0Gy. Results All cases completed treatment on schedule. Radiotherapy 40Gy, neck metastasis regression rate was higher than the radiotherapy alone group (C, B, A were 73.07%, 64.28%, 5 4.3 5%). At the end of 1 ~ 2 months, the complete remission rate of cervical metastases in the combined group, especially in the HD DDP group was significantly higher than that of the radiotherapy alone group (100%, 92.86%, 82.8%, respectively). 61%). Nasopharyngeal primary lesion remission rate also increased (C, B, A group were 88.46%, 78.5 7%, 68.5 7%). Toxicity was mainly manifested by the higher gastrointestinal reaction and 1 ~ 3 myelosuppression and hair loss in the combination group than in the radiotherapy alone group. There was no significant difference between the B and C groups, and none of them had renal function