【摘要】 目的：探讨化疗对局部中晚期鼻咽癌放疗远期疗效的影响。方法：９０例Ⅲ、Ⅳ期鼻咽低分化鳞癌病人随机分为放疗加化疗组（放化组）和单纯放疗组（单放组）进行研究，每组４５例。单放组采用钴－６０或９ＭｅＶ光子线以常规分割及分段治疗的方式照射颅底、鼻咽及颈部三个区域。鼻咽剂量６５～７５Ｇｙ，颈部根治剂量６０～７５Ｇｙ，残留病灶追加照射１０Ｇｙ左右。放化组除接受上述放疗外，还接受ＤＤＰ加５－ＦＵ化疗两程。第一程在放疗前１周进行，第二程在照射４０Ｇｙ后进行。结果：放化组１、３、５年生存率分别为９３．３％、７３．３％、６８．９％；单放组分别为８８．９％、５７．８％、４８．９％，两组比较差异显著（Ｐ＜０．０５）。放化组１、３、５年局控率分别为８８．９％、７１．１％、６６．７％；单放组分别为８２．３％、４８．９％、４６．７％，两组比较也有显著差异（Ｐ＜０．０５）。放化组出现远处转移的平均时间２０．３个月，单放组８．２个月，两组比较有显著差异（Ｐ＜０．０２）。结论：ＤＤＰ加５－ＦＵ化疗能提高局部中晚期鼻咽癌放疗的生存率、局控率及延长出现远处转移的时间。更多还原

【Abstract】 Purpose: A prospective study was conducted to study the influence of radiochemotherapy on the long-term results for stage Ⅲ、Ⅳ nasopharygeal carcinoma. Methods: Ninety patients with histologically proven nasopharyngeal carcinoma in Ⅲ、Ⅳ stage were randomized into two groups. ① Radiotherapy group (45 cases) only received radiotherapy with 65～75 Gy in nasopharynx and 60～75 Gy in the neck. Booster radiotherapy (10 Gy/five fractions) was given to any residual tumors. The conventional fractionation radiotherapy and split cource radiation were employed. ② Radiochemotherapy group (45 cases) received the same radiotherapy as the radiotherapy group and two cycles of chemotherapy with cisplatin and 5-fluorouracil. The first cycle of chemotherapy was given one week before radiotherapy and the second was given after 40 Gy of radiotherapy. Results: The patients characteristics, including staging and radiation dose, were similar in both groups. The 1, 3, 5-year survival were 93.3%, 73.3%, 68.9% respectively in radiochemotherapy group and 88.9%, 57.8%, 48.9% respectively in radiotherapy group, with significant difference between the two groups (P<0.05). The 1, 3, 5-year local disease control in radiochemotherapy group were 88.9%, 71.1%, 66.7% respectively in contrast to 82.3%, 48.9%, 46.7% respectively in radiotherapy group (P<0.05). Distant metastasis occured in 26 cases. The average time of occurrence of distant metastasis was 20.3 months in radiochemotherapy group and 8.2 months in radiotherapy group. There was significant difference in both groups (P<0.02). Conclusion: Chemotherapy with DDP and 5-FU plus radiotherapy can increase the survival rates and local disease control, and prolong the time of distant metastasis for stage Ⅲ, Ⅳ nasopharyngeal carcinoma.更多还原