Chan A T, Teo P M, Leung T W, Johnson P J
Department of Clinical Oncology, Sir Y.K. Pao Cancer Centre, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories.
Cancer. 1998 Mar 15;82(6):1003-12. doi: 10.1002/(sici)1097-0142(19980315)82:6<1003::aid-cncr1>3.0.co;2-f.
Nasopharyngeal carcinoma (NPC) is a radiosensitive tumor for which there is a high local control rate after radical radiotherapy (RT). However, for patients with locoregionally advanced disease, the rate of distant metastasis is high and the 5-year overall survival rate is poor.
A review of retrospective and prospective clinical studies was performed to assess the role of chemotherapy in three settings: metastatic disease; neoadjuvant and/or adjuvant; and concurrent chemotherapy with radiotherapy.
Cisplatin-based combination chemotherapy results in a high response rate in patients with metastatic NPC, and a subgroup may achieve long term disease free survival. The use of neoadjuvant and adjuvant chemotherapy to treat locoregionally advanced disease has resulted in consistently high response rates, but no randomized trial to date has demonstrated an improvement in overall survival. A recent Head and Neck Intergroup study randomized patients in the United States to receive concurrent chemotherapy (cisplatin) and radiotherapy or radiotherapy only. Although this approach demonstrated significant benefit in overall survival favoring the use of concurrent chemotherapy and radiotherapy, its applicability in geographic areas of high NPC incidence remains to be proven.
NPC is a chemosensitive tumor, and patients with metastatic disease have a high response rate. Further prospective studies will define the standard approach to treating locoregionally advanced NPC, which is likely to incorporate into the primary treatment some form of systemic chemotherapy.
鼻咽癌（NPC）是一种对放疗敏感的肿瘤，根治性放疗（RT）后局部控制率较高。然而，对于局部区域晚期疾病患者，远处转移率较高，5年总生存率较差。
对回顾性和前瞻性临床研究进行综述，以评估化疗在三种情况下的作用：转移性疾病；新辅助和/或辅助治疗；以及与放疗同步进行的化疗。
以顺铂为基础的联合化疗在转移性鼻咽癌患者中产生较高的缓解率，且一部分亚组患者可实现长期无病生存。使用新辅助和辅助化疗治疗局部区域晚期疾病的缓解率一直较高，但迄今为止尚无随机试验证明总生存率有所提高。最近一项头颈组间研究将美国患者随机分为接受同步化疗（顺铂）加放疗或单纯放疗两组。尽管这种方法在总生存率方面显示出显著益处，支持使用同步化疗和放疗，但在鼻咽癌高发地区的适用性仍有待证实。
鼻咽癌是一种对化疗敏感的肿瘤，转移性疾病患者缓解率较高。进一步的前瞻性研究将确定治疗局部区域晚期鼻咽癌的标准方法，该方法可能会在初始治疗中纳入某种形式的全身化疗。
