Lee Anne W M, Yau T K, Wong Dominique H M, Chan Elian W K, Yeung Rebecca M W, Ng W T, Tong Macy, Soong Inda S, Sze W M
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China.
Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1331-8. doi: 10.1016/j.ijrobp.2005.05.061. Epub 2005 Sep 19.
To explore a more effective strategy for treating nasopharyngeal carcinoma with extensive locoregional disease.
Between October 1998 and January 2003, 49 patients with Stage IV(A-B) disease infiltrating or abutting neurologic structures were treated with induction-concurrent chemotherapy and accelerated radiotherapy (RT). A combination of cisplatin and 5-fluorouracil was used in the induction phase and single-agent cisplatin in the concurrent phase. All patients were irradiated with conformal techniques at 2 Gy/fraction, six daily fractions weekly, to a total dose of 70 Gy.
Although 92% of patients had one or more acute toxicities Grade 3 or worse, 96% completed the whole course of RT, and 92% had five or more cycles of chemotherapy. The great majority of toxicities were uneventful, but 1 patient died of neutropenic sepsis. With a median follow-up of 3.1 years, 20 patients had failure at one or more sites and 15 patients died. The 3-year locoregional and distant failure-free rate was 77% and 75%, respectively, and the overall survival rate was 71%. At last follow-up, 27% of patients had developed late Grade 3 or worse toxicity (24% were hearing impairments), but none had radiation-induced neurologic damage.
The current strategy achieved encouraging results for this poor prognostic group, and confirmation of the therapeutic gain by a prospective randomized trial is warranted.
探索一种更有效的治疗局部区域病变广泛的鼻咽癌的策略。
1998年10月至2003年1月期间，49例IV（A - B）期病变浸润或紧邻神经结构的患者接受了诱导同步化疗和加速放疗（RT）。诱导期使用顺铂和5 - 氟尿嘧啶联合方案，同步期使用单药顺铂。所有患者采用适形技术照射，每次2 Gy，每周6次，总剂量70 Gy。
尽管92%的患者出现一种或多种3级或更严重的急性毒性反应，但96%的患者完成了整个放疗疗程，92%的患者接受了五个或更多周期的化疗。绝大多数毒性反应平稳，但有1例患者死于中性粒细胞减少性败血症。中位随访3.1年，20例患者出现一个或多个部位的复发，15例患者死亡。3年局部区域无复发生存率和远处无复发生存率分别为77%和75%，总生存率为71%。在最后一次随访时，27%的患者出现3级或更严重的晚期毒性反应（24%为听力障碍），但无一例发生放射性神经损伤。
当前策略对这一预后不良的群体取得了令人鼓舞的结果，有必要通过前瞻性随机试验来证实治疗效果的提升。
