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[目的]评价局部晚期鼻咽癌新辅助化疗加同期调强放化疗的临床近期疗效和急性反应。[方法]初治局部晚期鼻咽癌患者127例,2003年UICC分期Ⅲ期71例,Ⅳ期56例。104例完成新辅助化疗+同期化疗,23例完成同期增敏化疗(每周1次,共6～7次)。全组患者均采用全靶区调强放射治疗,处方剂量:GTVnx69.0～75.9Gy/30～33F、PGTVnx69.0～69.9Gy/30～33F、PTV160.0Gy/30～33F、PTV250.9～54.0Gy/28～30F、GTVnd67.5～69.9Gy/30～33F。急性反应评价标准参考RTOG评估标准。[结果]中位随访8个月,远处转移5例;1年局部控制率100%,1年总生存率(OS)99.2%,1年无远处转移生存率95.3%。[结论]局部晚期鼻咽癌新辅助化疗加同期调强放化疗是可行的,3～4级急性黏膜炎和3～4级血液学毒性是限制化疗进行的主要因素。
[Objective] To evaluate the clinical efficacy and acute response of neoadjuvant chemotherapy combined with adjuvant radiochemotherapy in locally advanced nasopharyngeal carcinoma. [Method] There were 127 newly diagnosed locally advanced nasopharyngeal carcinoma patients. There were 71 cases of UICC stage Ⅲ in 2003 and 56 cases of stage Ⅳ. 104 cases completed neoadjuvant chemotherapy + concurrent chemotherapy, 23 cases completed the same period of sensitization chemotherapy (once a week, a total of 6 to 7 times). All the patients were treated with IMRT. The prescription dose of GTVnx69.0 ~ 75.9Gy / 30 ~ 33F, PGTVnx69.0 ~ 69.9Gy / 30 ~ 33F, PTV160.0Gy / 30 ~ 33F, PTV250.9 ~ 54.0 Gy / 28-30F, GTVnd67.5-69.9 Gy / 30-33F. Acute reaction evaluation criteria reference RTOG evaluation criteria. [Results] The median follow-up was 8 months and distant metastasis was 5 cases. The 1-year local control rate was 100%, the 1-year overall survival rate was 99.2%, and the one-year distant metastasis-free survival rate was 95.3%. [Conclusion] Neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma plus concurrent chemo-radiotherapy is feasible. Grade 3 to 4 acute mucositis and grade 3 to 4 hematologic toxicities are the main factors restricting chemotherapy.