目的：探讨一种适合对鼻咽癌进行综合治疗的方法。方法：对153例鼻咽癌随机分组研究；单纯放疗组(甲组)52例、放疗前诱导化疗组(乙组)52例、放疗同步化疗组(丙组)49例，各组均采用60Coγ射线或4MVX线常规分割放疗，颈部加180KVX射线。鼻咽部剂量70～80Gy/7～8W，颈部预防照射50Gy/5W，根治量60～75Gy/6～7.5W。乙组在放疗前予DDP50mg，第1，5天，5-Fu500mg，第1～5天，静滴，休息2周，再重复上述方案。丙组在放疗开始同时给予DDP20mg,第1～5天，5-Fu 500mg，第1～5天，静滴，第4周再重复上述方案。结果：甲、乙、丙组鼻咽部肿瘤完全消退率为90.4％、75.0％、89.8％。颈部转移灶除N0者外，全消率分别为75.7％、64.5％、75.0％。按临床分期比较消退率Ⅱ、Ⅲ、Ⅳa期，甲组分别为85.7％、71.4％、60％，乙组分别为70％、58.3％、66.6％，丙组分别为81.3％、72.7％、63.4％。但经统计学处理，均无显著性差异(P＞0.05)。结论：鼻咽癌综合治疗与单纯放疗疗效比较，晚期病例的近期疗效稍有提高，长期疗效有待进一步观察。%Objective: To study the methods of combination treatment nasopharygeal carcinoma. Methods: 153 patients with nasopharygeal carcinoma were randomly divided into three groups. 49 patients radiotherapy (RT) alone (group A). 52 patients received induction chemotherapy before RT with DDP (50mg,d1,5), 5-Fu (500mg, d1～5) for 2 cycles (group B). 52 patients received chemotherapy with DDP (20mg, d1～5), 5-Fu (500mg, d1～5) in first and fourth week of RT (group C). RT in three groups was similar, patients in convention factionation received 2Gy/per fraction, five fraction/per week, with the total dose of 70～80Gy/7～8 week to nasopharynx, 60～75Gy/6～7.5 week to lymph nose node involvement and 50Gy in regionally lymphatic drainage. Results: Nasopharynx complete remission rate of group A, group B and group C were 90.4%, 75.0% and 89.8% respectively (P＞0.05). Cervical node complete remission rate of group A, group B and group C were 75.7%, 64.5% and 75.0%, respectively (P＞0.05). At Ⅱ stage, CR rate of group A, group B and group C were 85.7%, 70% and 81.3%,respectively (P＞0.05). At Ⅲ stage, CR rate of group A, group B and group C were 71.4%, 58.3% and 72.7%, respectively (P＞0.05). At Ⅳa stage, CR rate of group A, group B and group C were 60%, 66.6 % and 63.4%, respectively (P＞0.05). Conclusions:The near-term results of combination treatment for advanced nasopharygeal carcinoma is better than radiotherapy alone. The long-term survival remains to be answered.
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