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目的:观察FPH(顺铂+氟尿嘧啶+羟基喜树碱)方案联合放疗治疗晚期鼻咽癌的近期疗效、毒性反应及生存期。方法:46例患者均为经病理组织学确诊的晚期鼻咽癌患者,有可测量的肿瘤病灶,未经放疗、化疗或手术。采用面颈联合野(或整体挡铅)加颈部及锁骨上野,放疗剂量DT38Gy-40Gy后缩野及颈髓挡铅。放疗总量DT66Gy-70Gy,颈部预防量DT50Gy,治疗量DT66Gy-70Gy。采用含羟基喜树碱、顺铂及氟尿嘧啶化疗。放疗前先化疗1周期,放疗结束继续化疗,每4周重复,连续3周期。按照标准评价疗效和毒性。结果:全组46例均可评价,总有效率93.48%(43/46)。随访5年,3年后有29例生存,生存率为63.04%(29/46),3年后失访2例,按死亡计算,5年后20例生存,生存率为43.48%(20/46),其中Ⅲ期8例,为57.14%(8/14),Ⅳ期12例,为37.50%(12/32)。主要毒性反应为骨髓抑制、胃肠道反应及局部口腔黏膜、软组织放疗反应,均可耐受。结论:FPH方案联合放疗治疗晚期鼻咽癌疗效肯定,毒副作用可以耐受,值得临床进一步推广。
OBJECTIVE: To observe the short-term curative effect, toxicity and survival of advanced nasopharyngeal carcinoma treated with FPH (cisplatin plus fluorouracil plus hydroxycamptothecin) in combination with radiotherapy. Methods: All 46 patients were pathologically diagnosed with advanced nasopharyngeal carcinoma and had measurable tumor lesions without radiotherapy, chemotherapy or surgery. The use of facial and neck joint field (or block the lead) plus the neck and clavicle Ueno, radiation dose DT38Gy-40Gy after retraction and cervical blockade of lead. The total amount of radiotherapy DT66Gy-70Gy, neck prevention DT50Gy, the treatment of DT66Gy-70Gy. The use of hydroxy camptothecin, cisplatin and fluorouracil chemotherapy. Chemotherapy before radiotherapy 1 cycle, radiotherapy at the end of chemotherapy, repeated every 4 weeks for 3 cycles. According to the standard evaluation of efficacy and toxicity. Results: All 46 cases can be evaluated, the total effective rate was 93.48% (43/46). After 5 years of follow-up, 29 patients survived 3 years later and the survival rate was 63.04% (29/46). Two patients were lost to follow-up after 3 years. According to the death rate, 20 patients survived 5 years later and the survival rate was 43.48% 46), of which 8 cases were in stage Ⅲ, 57.14% (8/14) in stage Ⅲ, and 12 cases in stage Ⅳ were 37.50% (12/32). The main toxicity is myelosuppression, gastrointestinal reactions and local oral mucosa, soft tissue radiotherapy response, can be tolerated. Conclusion: The combination of FPH and radiotherapy for the treatment of advanced nasopharyngeal carcinoma is effective and tolerable. It is worth further clinical promotion.