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[目的]比较诱导化疗加放疗与同期放化疗治疗局部晚期鼻咽癌的疗效。[方法]收集2007年1月至2009年12月中山大学附属肿瘤医院收治的经病理证实的局部晚期鼻咽癌258例,其中采用顺铂+5-Fu诱导化疗加调强放疗(诱导组)128例,采用顺铂同期放化疗(同期组)130例。应用Kaplan-Meier和Log-rank方法计算和比较两组患者的生存率,应用COX风险回归模型进行预后多因素分析。[结果]诱导组和同期组5年总生存率(83.1%vs 83.0%)、无瘤生存率(80.9%vs 79.1%)、无转移生存率(84.9%vs 83.6%)、无复发生存率(95.0%vs 92.8%)比较差异均无统计学意义(P>0.05)。同期组3、4级恶心呕吐的发生率明显高于诱导组(10%vs1.6%,P=0.004),体重下降的平均数也明显大于诱导组(P<0.001)。多因素分析结果显示N分期是影响局部晚期鼻咽癌总生存的独立因素。[结论]诱导化疗加调强放疗治疗局部晚期鼻咽癌的疗效与同期放化疗相近,但同期放化疗的消化道反应较重。远处转移是局部晚期鼻咽癌治疗失败的主要原因。
[Objective] To compare the curative effect of induction chemotherapy plus radiotherapy and concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma. [Method] A total of 258 patients with locally advanced nasopharyngeal carcinoma confirmed by pathology were enrolled from Affiliated Tumor Hospital of Sun Yat-sen University from January 2007 to December 2009. The patients were treated with cisplatin plus 5-Fu induction chemotherapy plus intensity-modulated radiotherapy (induction group) 128 cases, the same period of cisplatin radiotherapy and chemotherapy (same period group) 130 cases. The Kaplan-Meier and Log-rank methods were used to calculate and compare the survival rates of two groups. Multivariate analysis of prognosis was performed using the COX risk regression model. [Results] The 5-year overall survival rate (83.1% vs 83.0%), tumor-free survival rate (80.9% vs 79.1%), metastasis-free survival rate (84.9% vs 83.6%) and relapse-free survival rate 95.0% vs 92.8%, respectively) showed no significant difference (P> 0.05). The incidence of nausea and vomiting in groups 3 and 4 was significantly higher than that in induction group (10% vs 1.6%, P = 0.004), and the average weight loss was significantly greater than that in induction group (P <0.001). Multivariate analysis showed that N stage was an independent factor affecting the overall survival of locally advanced NPC. [Conclusion] Adjuvant chemotherapy combined with intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma is similar to that of concurrent chemoradiotherapy. However, the chemoradiation with concurrent chemoradiotherapy has more severe gastrointestinal reactions. Distant metastasis is the main reason for the failure of locally advanced nasopharyngeal carcinoma.