Chi K H, Chan W K, Cooper D L, Yen S H, Lin C Z, Chen K Y
Cancer Therapy Center, Veterans General Hospital-Taipei, Taiwan.
Cancer. 1994 Jan 15;73(2):247-52. doi: 10.1002/1097-0142(19940115)73:2<247::aid-cncr2820730203>3.0.co;2-7.
Systemic disease progression occurs in the majority of patients with locally advanced nasopharyngeal carcinoma (NPC). Although a variety of chemotherapeutic drugs have had tumoricidal activity, the roles of chemotherapy and optimal regimens must be further defined. Based on high response rates of Cisplatin, 5-Fluororacil and Leucovorin (PFL) in patients with advanced squamous cell cancers of the head and neck, we tested a new outpatient PFL chemotherapy program in patients with advanced NPC.
Patients with NPC and 1) previously untreated, locally advanced disease; 2) local regional recurrence (LR) after radiotherapy; or 3) metastatic disease were eligible for study. Cisplatin 20 mg/m2/d, 5-FU 800 mg/m2/d and Leucovorin 90 mg/m2/d were administered simultaneously by continuous 96-hour intravenous infusion every three weeks. Patients were evaluated for response, survival, and toxicity.
Thirty-five patients were studied. The response rates of PFL therapy were 100% (15% complete response [CR], 85% partial response [PR]) in 20 patients with locally advanced or locally recurrent disease, and 80% (13.3% CR, 67.7% PR) in 15 patients with metastatic disease. The overall median survival was 20 months after therapy (range, 2-21). The median survival rate for previously untreated, locally advanced patients was not reached. The median survival rate for previously treated, local recurrence was 34 months and for metastatic patients was 14 months. Mucositis and leukopenia were the dose-limiting toxicities (20-23%, grade III) and occurred more frequently in patients previously irradiated. No treatment-related deaths occurred.
Outpatient PFL chemotherapy is active, safe, and convenient for advanced stage nasopharyngeal carcinoma patients, and the overall toxicities are tolerable.
大多数局部晚期鼻咽癌（NPC）患者会出现全身疾病进展。尽管多种化疗药物具有杀瘤活性，但化疗的作用及最佳方案仍需进一步明确。基于顺铂、5-氟尿嘧啶和亚叶酸（PFL）对晚期头颈部鳞状细胞癌患者的高缓解率，我们在晚期NPC患者中测试了一种新的门诊PFL化疗方案。
符合以下条件的NPC患者可纳入研究：1）既往未治疗的局部晚期疾病；2）放疗后局部区域复发（LR）；或3）转移性疾病。顺铂20mg/m²/d、5-氟尿嘧啶800mg/m²/d和亚叶酸90mg/m²/d每三周通过持续96小时静脉输注同时给药。对患者的缓解情况、生存率和毒性进行评估。
共研究了35例患者。20例局部晚期或局部复发性疾病患者的PFL治疗缓解率为100%（完全缓解[CR]15%，部分缓解[PR]85%），15例转移性疾病患者的缓解率为80%（CR 13.3%，PR 67.7%）。治疗后的总体中位生存期为20个月（范围2-21个月）。既往未治疗的局部晚期患者的中位生存期未达到。既往治疗后局部复发患者的中位生存期为34个月，转移性患者为14个月。黏膜炎和白细胞减少是剂量限制性毒性（20%-23%为Ⅲ级），且在既往接受过放疗的患者中更常见。未发生与治疗相关的死亡。
门诊PFL化疗对晚期鼻咽癌患者有效、安全且方便，总体毒性可耐受。
