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目的 :探讨同期化疗加放疗对中晚期鼻咽癌远期疗效的影响。方法 :88例Ⅲ、Ⅳa期鼻咽癌 (′92分期 )随机分为化疗加放疗组 (放化组 44例 )和单纯放疗组 (单放组 44例 )。单放组采用60 Co加 180kvX线常规分割 ,鼻咽部及颈切线用60 Co γ线 ,颈部垂直野用 180kvX射线。鼻咽部剂量 6 5— 78Gy ,颈部根治量 6 0— 72Gy ,残留病灶加 10Gy左右 ,放化组加用顺铂 (DDP)及氟尿嘧啶 (5 FU)化疗 3疗程 ,第一疗程在放疗前 1周 ,第二疗程在放疗 40Gy左右时 ,第三疗程放疗结合后 1个月进行。结果 :一、三、五年生存率放化疗组分别为 86 4%、77 3%、5 0 % ;单放组为79 5 %、6 8 2 %、40 9% ,两组比较无显著差异 (P >0 0 5 ) ,一、三、五年局控率放化疗组分别为 84 1%、6 8 1%、47 7% ,单放组分别为 81 8%、47 7%、38 6 % ,两组比较无显著差异 (P >0 0 5 )。放化疗组出现远处转移平均时间18 6个月 ,单放组 8 8个月 ,两组比较有显著差异 (P <0 0 5 )。结论 :同期DDP加 5 FU化疗未能提高局部中晚期鼻咽癌放疗的生存率、局控率 ,但能延长远处转移时间
Objective: To investigate the effect of concurrent chemotherapy and radiotherapy on long-term efficacy of advanced nasopharyngeal carcinoma. Methods: Eighty-eight patients with stage Ⅲa and Ⅳa nasopharyngeal carcinoma (’92 stage) were randomly divided into chemotherapy plus radiotherapy group (44 patients in radiotherapy group) and radiotherapy group (44 patients in radiotherapy group). Single group with 60 Co plus 180kvX line conventional segmentation, nasopharyngeal and neck tangential with 60 Co γ line, vertical neck 180kv X-ray. Nasopharyngeal dose 6 5-78 Gy, neck radical dose 60-72Gy, residual lesions plus 10Gy, radiotherapy and chemotherapy plus cisplatin (DDP) and 5-fluorouracil (5 FU) chemotherapy 3 courses, the first course of treatment before radiotherapy 1 week, the second course of treatment in the 40Gy radiotherapy when the third course of radiotherapy combined with 1 month. Results: The 1-, 3-, and 5-year survival rates were 86.4%, 77.3% and 50% in the radiotherapy and chemotherapy groups, 79.5%, 68.2% and 40.9% in the radiotherapy alone group, with no significant difference between the two groups (P> 0.05). The rates of local control and chemotherapy in one, three and five years were 84.1%, 68.1% and 47.7%, respectively, and 81.8%, 47.7% and 386 %, No significant difference between the two groups (P> 0.05). In the radiotherapy and chemotherapy group, the mean time of distant metastasis was 18 6 months and that in the radiotherapy alone group was 8 8 months. There was significant difference between the two groups (P <0.05). Conclusions: DDP plus 5 FU chemotherapy during the same period failed to improve the survival rate and the rate of local radiotherapy for locally advanced nasopharyngeal carcinoma, but prolonged distant metastasis