Chua Daniel T T, Sham Jonathan S T, Au Gordon K H
Department of Clinical Oncology, PB 115, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
Head Neck. 2004 Feb;26(2):118-26. doi: 10.1002/hed.10362.
To evaluate the toxicity and efficacy of concurrent chemoirradiation with cisplatin followed by adjuvant ifosfamide, 5-fluorouracil and leucovorin in patients with stage IVb nasopharyngeal carcinoma (NPC) PATIENTS AND METHODS: Between October 1998 and August 2001, 35 Chinese patients with stage IVb NPC (N3a:12, N3b:23) were treated with by concurrent chemoirradiation using cisplatin 100 mg/m2 on days 1, 22, and 43 of radiotherapy, followed by adjuvant chemotherapy with 1.4 g/m2, ifosfamide, 450 mg/m2 5-fluorouracil, and 20 mg/m2 leucovorin daily for 5 days and repeated every 3 weeks for three cycles. Radiotherapy was given using standard fractionation at 2 Gy/day to a total of 68 Gy to the nasopharynx and 66 Gy to the neck.
All patients completed the prescribed radiotherapy. Twenty-three patients (66%) completed all scheduled cycles of chemotherapy. The compliance rate for concurrent and adjuvant chemotherapy was 71% and 80%, respectively. Grade 3 mucositis occurred in 37%, and grade 3 dermatitis occurred in 11.5% during radiotherapy. Grade 3 neutropenia occurred in 17% during concurrent chemotherapy, and grade 3-4 neutropenia occurred in 48.5% during adjuvant chemotherapy. There were no treatment-related deaths. With a median follow-up of 31 months, the 3-year relapse-free rate was 60%, and the 3-year overall survival rate was 74%. Locoregional control was excellent, with a 3-year local and nodal relapse-free rate of 91% and 83%, respectively. Eleven patients (31%) had developed distant metastases, and the 3-year distant metastasis-free rate was 66%.
The chemotherapy regimen tested is practical with an acceptable compliance rate. Despite having a more advanced stage disease, the observed outcome of our patients seems to be comparable with other series using platinum-based adjuvant chemotherapy. Further investigation to confirm the benefit of using the study regimen in advanced stage NPC is warranted.
评估顺铂同步放化疗后序贯异环磷酰胺、5-氟尿嘧啶和亚叶酸钙辅助化疗方案治疗IVb期鼻咽癌（NPC）患者的毒性和疗效。
1998年10月至2001年8月期间，35例中国IVb期NPC患者（N3a：12例，N3b：23例）接受了顺铂同步放化疗，放疗第1、22和43天给予顺铂100mg/m²，随后进行辅助化疗，异环磷酰胺1.4g/m²、5-氟尿嘧啶450mg/m²和亚叶酸钙20mg/m²，每日1次，共5天，每3周重复1次，共3个周期。放疗采用标准分割，每天2Gy，鼻咽部总剂量68Gy，颈部总剂量66Gy。
所有患者均完成了规定的放疗。23例患者（66%）完成了所有计划的化疗周期。同步化疗和辅助化疗的依从率分别为71%和80%。放疗期间37%的患者发生3级黏膜炎，11.5%的患者发生3级皮炎。同步化疗期间17%的患者发生3级中性粒细胞减少，辅助化疗期间48.5%的患者发生3-4级中性粒细胞减少。无治疗相关死亡。中位随访31个月，3年无复发生存率为60%，3年总生存率为74%。局部区域控制良好，3年局部和区域无复发生存率分别为91%和83%。11例患者（31%）发生远处转移，3年无远处转移生存率为66%。
所测试的化疗方案切实可行，依从率可接受。尽管患者疾病分期较晚，但观察到的结果似乎与其他使用铂类辅助化疗的系列研究相当。有必要进一步研究以证实该研究方案对晚期NPC患者的益处。
