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[目的]评价调强放疗联合含奈达铂方案化疗治疗局部晚期鼻咽癌的临床疗效及不良反应。[方法]166例Ⅲ、Ⅳa期初治鼻咽癌患者接受调强放疗联合同期含奈达铂方案化疗。调强放疗采用鼻咽及全颈同步整合加量(SIB)技术,按两进程给予:鼻咽部剂量70Gy/32F,颈部淋巴结剂量66Gy/32F,颈部预防剂量高危区60Gy/32F、低危区50.4Gy/28F。放疗期间同步化疗2个周期,21d为1个周期。含奈达铂化疗方案分为3组:FP(5-氟尿嘧啶+奈达铂)58例;TP(紫杉醇+奈达铂)62例;TFP(紫杉醇+5-氟尿嘧啶+奈达铂)46例。分析比较3组患者的疗效和急性不良反应。[结果]166例患者全部按计划完成同期放化疗。中位随访43个月,FP组的4年总生存率、局部控制率、区域控制率及无远处转移生存率分别为81.5%、93.0%、98.2%、79.0%,TP组为81.7%、91.4%、96.8%、82.0%,TFP组为84.7%、90.8%、93.3%、81.9%。3组间比较总生存率(P=0.752)、局部控制率(P=0.961)、区域控制率(P=0.423)及无远处转移生存率(P=0.836)均无显著性差异。治疗相关不良反应主要为骨髓抑制、胃肠道反应、放射性口腔黏膜炎。3组患者Ⅲ～Ⅳ级急性不良反应发生率分别为17.2%vs22.6%vs41.3%,差异有显著性(P=0.016),TFP组较TP组及FP组发生率明显增加(P=0.037,P=0.007)。多因素分析结果表明N分期是影响患者总生存率(P=0.036)和无远处转移生存率(P=0.037)的独立预后因素。[结论]调强放疗联合同期含奈达铂方案化疗治疗局部晚期鼻咽癌,可获得较好肿瘤控制和生存率,患者顺应性好,反应可耐受。TFP三药方案较FP、TP两药方案急性不良反应的发生明显增加,临床疗效相近。N分期是影响预后的主要因素,远处转移是治疗失败的主要原因。
[Objective] To evaluate the clinical efficacy and adverse reactions of intensity modulated radiotherapy combined with nedaplatin chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma. [Method] 166 patients with stage Ⅲ and Ⅳa nasopharyngeal carcinoma were treated with IMRT combined with Nedaplatin-containing chemotherapy. Intensity modulated radiotherapy using nasopharyngeal and total neck synchronous integration plus volume (SIB) technology, given by two processes: nasopharyngeal dose of 70Gy / 32F, cervical lymph node dose 66Gy / 32F, neck preventive dose of high-risk area 60Gy / 32F, low Dangerous 50.4Gy / 28F. Chemotherapy during radiotherapy 2 cycles, 21d for a cycle. Nedaplatin-containing chemotherapy regimens were divided into three groups: 58 FP (5-fluorouracil + Nedaplatin), 62 TP (paclitaxel + nedaplatin) and 46 TFP (paclitaxel + 5- fluorouracil + Nedaplatin). Analysis and comparison of the efficacy and acute adverse reactions in 3 groups of patients. [Results] All 166 patients completed the concurrent chemoradiotherapy according to plan. With a median follow-up of 43 months, the 4-year overall survival, local control, regional control and distant metastasis-free survival rates in FP group were 81.5%, 93.0%, 98.2% and 79.0% respectively, and FP group was 81.7% 91.4%, 96.8%, 82.0%, TFP group was 84.7%, 90.8%, 93.3%, 81.9%. There was no significant difference between the three groups in overall survival (P = 0.752), local control (P = 0.961), regional control (P = 0.423) and distant metastasis-free survival (P = 0.836). Treatment-related adverse reactions are mainly myelosuppression, gastrointestinal reactions, radiation-induced oral mucositis. The incidence of grade Ⅲ ~ Ⅳ acute adverse reactions in the three groups were 17.2% vs22.6% vs41.3%, the difference was significant (P = 0.016). The incidence of TFP group was significantly higher than that of TP group and FP group (P = 0.037, P = 0.007). Multivariate analysis showed that N stage was an independent prognostic factor affecting overall survival (P = 0.036) and distant metastasis-free survival (P = 0.037). [Conclusion] IMRT combined with chemotherapy containing Nedraplatin in the treatment of locally advanced nasopharyngeal carcinoma can achieve better tumor control and survival rate. The patient has good compliance and the reaction is tolerable. TFP triple drug program FP, TP two acute side effects of the program significantly increased the incidence of clinical efficacy similar. N staging is the main factor affecting the prognosis, distant metastasis is the main reason for treatment failure.