Mertens R, Granzen B, Lassay L, Gademann G, Hess C F, Heimann G
Department of Pediatrics, University Rheinisch-Westfälische Technische Hochschule Aachen, Germany.
Cancer. 1997 Sep 1;80(5):951-9.
The increasing use of chemotherapy has improved the prognosis of patients with nasopharyngeal carcinoma (NPC), and the authors demonstrated the beneficial effect of adjuvant interferon (IFN)-beta in a previous pilot study of children with advanced stage NPC. The current multi-institutional, cooperative GPOH (Gesellschaft für Pädiatrische Onkologie und Hämatologie) study NPC-91 was begun in 1992 to determine the efficacy of preradiation chemotherapy, radiotherapy, and adjuvant IFN-beta, in the treatment of advanced stage NPC.
Of a total of 22 patients, 21 had American Joint Committee on Cancer Stage III or IV disease, and 1 had Stage II disease. The median age was 12 years (range, 8-16 years). Twenty of 22 received 3 courses of preradiation chemotherapy consisting of methotrexate 120 mg/m2 on Day 1, cisplatin 100 mg/m2 on Day 1, and 5-fluorouracil 1000 mg/m2 for five days as well as 6 doses of leucovorin 25 mg/m2 every six hours beginning on Day 2. The Stage II patient received no chemotherapy, and chemotherapy was terminated for another during the first course. All patients had radiation therapy, stratified by stage. The cumulative dose to the primary sites was 59.4 gray (Gy), with single doses of 1.8 Gy. A total of 45 Gy was delivered to the neck area. Finally, all patients were treated with recombinant IFN-beta (10(5) U per kg of body weight) 3 times a week for 6 months.
The response rate was 91%. These patients stayed in first remission during a median follow-up of 32 months. With the exception of one reversible cardiotoxicity, moderate chemotherapy-related toxicity was observed.
In this study, patients with advanced stage NPC had a good prognosis with treatment consisting of neoadjuvant cisplatin and 5-fluorouracil, radiotherapy, and adjuvant IFN-beta. It is particularly noteworthy that distant metastases did not develop.
化疗使用的增加改善了鼻咽癌（NPC）患者的预后，作者在先前一项针对晚期NPC儿童的试点研究中证明了辅助性干扰素（IFN）-β的有益作用。当前这项多机构合作的GPOH（德国儿科肿瘤学和血液学协会）研究NPC-91于1992年启动，旨在确定放疗前化疗、放疗以及辅助性IFN-β在晚期NPC治疗中的疗效。
总共22例患者中，21例患有美国癌症联合委员会III期或IV期疾病，1例患有II期疾病。中位年龄为12岁（范围8至16岁）。22例患者中有20例接受了3个疗程的放疗前化疗，包括第1天使用甲氨蝶呤120mg/m²、第1天使用顺铂100mg/m²、5-氟尿嘧啶1000mg/m²持续5天，以及从第2天开始每6小时使用6剂亚叶酸钙25mg/m²。II期患者未接受化疗，另1例在第一个疗程期间终止了化疗。所有患者均接受放疗，按分期分层。原发部位的累积剂量为59.4戈瑞（Gy），单次剂量为1.8Gy。颈部区域共给予45Gy。最后，所有患者接受重组IFN-β（每千克体重10⁵U）治疗，每周3次，共6个月。
缓解率为91%。这些患者在中位随访32个月期间保持首次缓解。除了1例可逆性心脏毒性外，观察到了中度的化疗相关毒性。
在本研究中，晚期NPC患者采用新辅助顺铂和5-氟尿嘧啶、放疗以及辅助性IFN-β治疗预后良好。特别值得注意的是未发生远处转移。
