Lin J C, Jan J S, Hsu C Y
Department of Radiation Oncology, Taichung Veterans General Hospital, Taiwan, Republic of China.
Am J Clin Oncol. 1996 Dec;19(6):624-7. doi: 10.1097/00000421-199612000-00019.
Distant metastasis has become the most frequent failure site-more so than locoregional relapse-after adequate radiotherapy in nasopharyngeal carcinoma (NPC). A prospective study was initiated to test the role of postradiation adjuvant chemotherapy using a weekly schedule for selected patients with high-risk NPC (N3, T4N2b-2c, and N2b-2c, with one of nodal size > 4 cm, or residual disease after radiotherapy). Through July 1993 to August 1994, a total of 20 patients were entered into the study: 16 men and four women, with a median age of 49 years and age range of 27-75 years. Pathology showed WHO type I:II:III = 2:13:5. Previous treatment consisted of concurrent chemoradiotherapy (16 patients), radiotherapy alone (two), and neoadjuvant chemotherapy followed by radiotherapy (two). Postradiation adjuvant chemotherapy was usually started 2 months after radiotherapy, using a weekly FP schedule (5-fluorouracil 1,250 mg/m2 + cisplatin 25 mg/m2, mixed in 100 ml saline, 24 h continuous i.v. infusion) for 18 weeks. The treatment of five patients was at 5, 6, 10, 14, and 15 weeks because of leukopenia-induced mortality, sudden death unrelated to adjuvant chemotherapy, a patient's refusal, and distant metastasis (the last two cases) during adjuvant chemotherapy. The major toxicity was leukopenia (grade I, 20%; grade II, 45%; grade III, 15%; and grade IV, 10%). Ten patients (50%) developed distant metastasis after a median follow-up time of 20 months. Our preliminary data indicate that postradiation adjuvant chemotherapy with a weekly FP regimen at our dosage is not recommended for high-risk NPC.
远处转移已成为鼻咽癌（NPC）在接受充分放疗后最常见的失败部位，比局部区域复发更为常见。一项前瞻性研究启动，旨在测试对于选定的高危鼻咽癌患者（N3、T4N2b - 2c和N2b - 2c，其中一个淋巴结大小>4 cm，或放疗后有残留病灶）采用每周方案进行放疗后辅助化疗的作用。从1993年7月至1994年8月，共有20例患者进入该研究：16例男性和4例女性，中位年龄49岁，年龄范围为27 - 75岁。病理显示世界卫生组织I型:II型:III型 = 2:13:5。既往治疗包括同步放化疗（16例患者）、单纯放疗（2例）以及新辅助化疗后放疗（2例）。放疗后辅助化疗通常在放疗后2个月开始，采用每周FP方案（氟尿嘧啶1250 mg/m² + 顺铂25 mg/m²，溶于100 ml生理盐水中，24小时持续静脉输注），共18周。5例患者因白细胞减少导致的死亡、与辅助化疗无关的猝死、患者拒绝以及辅助化疗期间的远处转移（最后2例），治疗分别在第5、6、10、14和15周时中断。主要毒性为白细胞减少（I级，20%；II级，45%；III级，15%；IV级，10%）。中位随访时间20个月后，10例患者（50%）发生远处转移。我们的初步数据表明，对于高危鼻咽癌患者，不推荐使用我们所采用剂量的每周FP方案进行放疗后辅助化疗。
