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目的比较≥N2期鼻咽癌新辅助化疗后放疗与单纯放疗的远期疗效。方法188例≥N_2期经病理证实的鼻咽癌患者被随机分为新辅助化疗组(A组)和单纯放疗组(B组),每组94例。A组于放疗前用DF方案(DDP、5-Fu)化疗2～3周期。两组放疗方法相同,全部病例用6MeV光子线常规分割放疗,鼻咽部剂量65～74Gy/6.5～8周,颈部剂量58-72Gy/5.8～7.2周。结果A组和B组鼻咽部肿瘤完全消退率分别是93.5%和87.2%,颈部转移淋巴结完全消退率分别为94.6%和90.3%,均无显著性差异(P>0.05)。两组5年生存率分别为70.8%和56.6%,A组高于B组(P<0.05)。A、B两组远处转移率分别为20.8%和30.2%,有显著性差异(P<0.05);平均转移时间为19个月和9个月,两组有显著性差异(P<0.01)。A组急性毒副反应较B组重,但未影响治疗进程。结论对≥N2期颈淋巴结转移的鼻咽癌患者放疗前化疗(新辅助化疗)能提高患者生存率和局部控制率,减少远处转移,延长出现转移的时间。
Objective To compare the long-term effects of radiotherapy and radiotherapy alone in patients with ≥N2 nasopharyngeal carcinoma after neoadjuvant chemotherapy. Methods A total of 188 patients with ≥N_2 stage nasopharyngeal carcinoma confirmed by pathology were randomly divided into neoadjuvant chemotherapy group (A group) and radiotherapy alone group (B group), 94 cases in each group. Group A before chemotherapy with DF program (DDP, 5-Fu) chemotherapy 2 to 3 cycles. The radiotherapy method was the same in both groups. Radiotherapy was routinely performed with 6 MeV photons in all cases. The dose of nasopharyngeal was 65-74 Gy / 6.5-8 weeks and the dose was 58-72 Gy / 5.8-7.2 weeks. Results The complete regression rate of nasopharyngeal tumors in group A and group B was 93.5% and 87.2%, respectively. The complete regression rate of cervical lymph node metastasis was 94.6% and 90.3%, respectively. There was no significant difference (P> 0.05). The 5-year survival rates of the two groups were 70.8% and 56.6%, respectively, and those in group A were higher than those in group B (P <0.05). The distant metastasis rates of group A and group B were 20.8% and 30.2% respectively, with significant difference (P <0.05). The average transfer time was 19 months and 9 months, there was significant difference between the two groups (P <0.01) . A group of acute toxicity than the B group, but did not affect the course of treatment. Conclusion Pretreatment chemotherapy (neoadjuvant chemotherapy) for NPC patients with cervical lymph node metastasis of grade ≧ N2 can improve the survival rate and local control rate, reduce the distant metastasis and prolong the time of metastasis.