Comparison of Long-term Efficacy of IMRT plus Concurrent Chemotherapy Versus Neoadjuvant Chemotherapy Followed by IMRT plus Concurrent Chemotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma
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摘要:目的
比较局部中晚期鼻咽癌诱导化疗+IMRT同期化疗与IMRT同期化疗的远期疗效。
方法诱导化疗+同期放化疗组（诱导组）118例，同期放化疗组（同期组）106例。诱导化疗方案为TP（多西他赛+顺铂）或PF（氟尿嘧啶+顺铂），同期化疗全部采用单药顺铂方案，全组病例均接受调强放疗。Kaplan-Meier法计算生存率，Log rank检验比较组间生存曲线。
结果诱导组与同期组5年OS、DFS、DMFS、RFS分别为83.9%和82.1%（P=0.768），86.1%和79.8%（P=0.216），89.5%和84.5%（P=0.264）,96.4%和90.8%（P=0.114）。亚组分析显示对于T晚期（T3-4N0-1）或N晚期（T1-4N2-3）的病例，诱导化疗均未明显提高OS、DFS、DMFS、RFS。两种诱导化疗方案TP与PF比较差异也无统计学意义。诱导组的血液系统不良反应及消化道不良反应较同期组明显增加。
结论诱导化疗的使用未明显提高局部中晚期鼻咽癌的远期生存率，且血液系统、消化道等不良反应明显增加。
Abstract:ObjectiveTo compare the long-term efficacy between two chemoradiotherapy regimens in locoregionally advanced nasopharyngeal carcinoma (LANPC) patients treated with intensity-modulated radiotherapy (IMRT): neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CCRT) versus CCRT alone.
MethodsNACT followed by CCRT (NACT+CCRT group,n=118) and CCRT alone (CCRT group,n=106) . The NACT+CCRT group received TP(docetaxel and cisplatin) or PF(cisplatin and 5-fluorouracil). All patients were treated with cisplatin concurrently with IMRT. The survival rates were assessed by Kaplan-Meier analysis,and the survival curves were compared using Log rank test.
ResultsThere was no significant difference between the NACT+CCRT group and CCRT group in 5-year OS(83.9% vs. 82.1%,P=0.768) ,DFS(86.1% vs. 79.8%,P=0.216) ,DMFS(89.5% vs. 84.5%,P=0.264) or RFS(96.4% vs. 90.8%,P=0.114) . Subgroup analysis showed that compared with CCRT,NACT+CCRT did not significantly improve 5-year OS,RFS,DMFS,DFS in patients with advanced T-stage disease (T3-4N0-l) or advanced N-stage disease (T1-4N2-3) . There was no significant difference in the survival between the induction TP and induction PF. There were significantly higher numbers of individuals with hematologic toxicity and gastrointestinal reactions in the NACT+CCRT group than those in the CCRT group .
ConclusionNACT does not significantly improve the long-term survival in the patients with LANPC moreover,it increases the risk of severe hematologic toxicity and gastrointestinal reactions.
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表 1 224例局部中晚期鼻咽癌患者临床特征分布（例）
Table 1 Characteristics of 224 patients with locoregionally advanced nasopharyngeal carcinoma (n)
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表 2 224例局部中晚期鼻咽癌不同治疗模式的远期疗效比较及亚组分析
Table 2 Summary of long-term survival and subset analyses in 224 patients with locoregionally advanced NPC between NACT+CCRT and CCRT group
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表 3 224例局部中晚期鼻咽癌患者不同治疗模式的不良反应分布与比较
Table 3 Treatment-related toxicities in 224 patients with locoregionally advanced NPC between NACT+CCRT and CCRT group
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