Cheng S H, Liu T W, Jian J J, Tsai S Y, Hao S P, Huang C H, Liu M C, Yu B, Huang A T
Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
Cancer J Sci Am. 1997 Mar-Apr;3(2):100-6.
The prognosis of stage III and IV nasopharyngeal carcinoma treated with radiation therapy alone is poor. To improve outcome, concomitant chemotherapy was incorporated into the treatment of locally advanced nasopharyngeal carcinoma.
Seventy-four patients with locally advanced nasopharyngeal carcinoma were prospectively treated with a combination of concomitant chemotherapy and computerized-tomography-assisted radiotherapy at Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, between April 1990 and December 1995. The first 29 patients who had a minimum of 2 years of follow-up were included in this report. Their median interval of follow-up was 42 months. The dose of radiation was 7000 cGy given in 35 fractions. Two courses of chemotherapy, consisting of cisplatin and 5-fluorouracil, were delivered simultaneously with radiotherapy during weeks 1 and 6, and two additional monthly courses were given after radiotherapy. Included in this study were four patients with stage III and 25 patients with stage IV disease.
Toxicities of concomitant radiotherapy and chemotherapy were acceptable and reversible. The locoregional control rate at 50 months was 88.2%, and the disease-free survival rate was 74.6%.
Our results demonstrate an improved survival with the addition of computerized tomography treatment planning and concomitant chemotherapy to radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma when compared with data in the current literature. However, a randomized trial comparing computerized-tomography-assisted radiotherapy with and without chemotherapy is necessary to confirm the contribution of chemotherapy.
单纯放疗治疗III期和IV期鼻咽癌的预后较差。为改善疗效，同步化疗被纳入局部晚期鼻咽癌的治疗中。
1990年4月至1995年12月期间，台湾台北市国父纪念馆中山癌症中心对74例局部晚期鼻咽癌患者进行了前瞻性同步化疗联合计算机断层扫描辅助放疗的治疗。本报告纳入了至少随访2年的前29例患者。他们的中位随访时间为42个月。放疗剂量为7000 cGy，分35次给予。在第1周和第6周放疗期间同步给予两周期由顺铂和5-氟尿嘧啶组成的化疗，放疗后再额外给予两周期每月一次的化疗。本研究纳入了4例III期患者和25例IV期患者。
同步放化疗的毒性反应可接受且可逆。50个月时的局部区域控制率为88.2%，无病生存率为74.6%。
与当前文献数据相比，我们的结果表明，在局部晚期鼻咽癌的治疗中，增加计算机断层扫描治疗计划和同步化疗可提高生存率。然而，需要进行一项比较有或无化疗的计算机断层扫描辅助放疗的随机试验，以证实化疗的作用。
