Lin J C, Chen K Y, Jan J S, Hsu C Y
Department of Radiation Oncology, Taichung Veterans General Hospital, Taiwan, R.O.C.
Int J Radiat Oncol Biol Phys. 1996 Dec 1;36(5):1127-36. doi: 10.1016/s0360-3016(96)00384-7.
A newly designed concomitant chemoradiotherapy was undertaken to assess the feasibility and efficacy for advanced nasopharyngeal carcinoma (NPC).
Sixty-three patients with biopsy-proven NPC were entered in this Phase II trial from March 1992 to November 1993. Most patients present with Stage IV disease (93.4%) and poorly differentiated epidermoid carcinoma or undifferentiated carcinoma were the major pathologic type. Radiotherapy was delivered using a telecobalt unit and 10 MV x-rays and by altered fractionation (72-74 Gy/45 fractions/6 weeks). Chemotherapy with cisplatin 75 mg/m2, 2 h infusion at day 1, followed by 5-FU 400 mg/m2/day, continously infused for 4 days was given concurrently during the first and fifth weeks of radiotherapy.
The major toxicity was mucositis (61% belong to Grade 3, 31% to Grade 2). Weight loss, leucopenia, and skin reaction were frequently encountered. Three patients withdrew from treatment at 15, 25, and 55.5 Gy, three patients interrupted the radiotherapy for 1-4.5 weeks, and two patients refused the second cycle of concomitant chemotherapy due to toxicities. The initial tumor response showed 100% overall response rate, with 90.5% complete response. After a median follow-up time of 38 months, five patients failed at the primary and/or neck (four recurrent and one persistent), and 14 patients developed distant metastases alone. The 3-year primary disease-free, regional disease-free, distant disease-free, and overall survival rates are 89.1, 92.8, 74.3, and 73.6%, respectively. The late complication rate is acceptable so far.
Our data indicates that concurrent chemoradiotherapy for advanced NPC is both feasible and effective, with acceptable toxicities. Distant metastases are the major site of treatment failure. Postradiation adjuvant chemotherapy to eradicate subclinical distant metastasis should be further studied.
采用一种新设计的同步放化疗方案来评估其对晚期鼻咽癌（NPC）的可行性和疗效。
1992年3月至1993年11月，63例经活检证实为NPC的患者进入该II期试验。大多数患者为IV期疾病（93.4%），主要病理类型为低分化表皮样癌或未分化癌。放疗采用远距离钴治疗机和10兆伏X射线，并采用改变分割方式（72 - 74戈瑞/45次分割/6周）。在放疗的第一周和第五周同时给予化疗，顺铂75毫克/平方米，第1天静脉输注2小时，随后5-氟尿嘧啶400毫克/平方米/天，持续静脉输注4天。
主要毒性反应为黏膜炎（61%为3级，31%为2级）。体重减轻、白细胞减少和皮肤反应也较为常见。3例患者分别在15、25和55.5戈瑞时退出治疗，3例患者放疗中断1 - 4.5周，2例患者因毒性反应拒绝接受第二个周期的同步化疗。初始肿瘤反应显示总有效率为100%，完全缓解率为90.5%。中位随访时间38个月后，5例患者在原发灶和/或颈部出现复发（4例复发，1例持续存在），14例患者单独出现远处转移。3年无原发疾病生存率、区域无疾病生存率、远处无疾病生存率和总生存率分别为89.1%、92.8%、74.3%和73.6%。目前晚期并发症发生率可以接受。
我们的数据表明，晚期NPC的同步放化疗既可行又有效，毒性反应可以接受。远处转移是治疗失败的主要部位。应进一步研究放疗后辅助化疗以根除亚临床远处转移。
