Objective To observe the short-term efficacy and acute adverse effect of inductive chemotherapy with docetaxel plus nedaplatin followed by concurrent treatment of nedaplatin and radiotherapy in patients with locally advanced nasopharyngeal carcinoma ( NPC). Methods Sixty patients with locally advanced NPC confirmed by histopathology were randomized into experimental group and control group. The patients received two cycles of inductive chemotherapy with docetaxel plus nedaplatin in experimental group or cisplatin plus 5 -fluorouracil in control group every 3 weeks, followed by concurrent radiotherapy and weekly nedaplatin or cisplatin chemotherapy. All the patients received intensity modulated radiotherapy (IMRT) which began at the 7th week. The prescription doses were as follows; GTVnx 68-70 Gy/30 fraction, GTVnd 66-68 Gy/30 fraction, CTV1 60-64 Gy/30 fraction, CTV2 50-54 Gy/30 fraction, 5 fraction/week. Results More chemotherapy cycles were finished in experimental group than in control group (7. 67 vs. 7. 17, t = 2. 574, P = 0. 013). The volume of GTVnx in experimental group and control group was reduced by 15.44 cm3 and 12. 21 cm3 respectively after inductive chemotherapy (P> 0. 05 ) . The volume of GTVnd in experimental group and control group was reduced by 8. 97 cm3 and 6. 74 cm3, respectively ( P> 0.05). There was no significant difference in complete response rate between the two groups (P>0. 05). Incidence rate of grade 3-4 neutropenia was higher in experimental group than in control group (33. 3% vs. 10. 0% , t = 4. 812, P0. 05). Conclusion Treatment with docetaxel plus nedaplatin is effective and well-tolerated in patients with locally advanced NPC. The short-term efficacy between experimental group and control group is similar. Experimental group also shows a significant superiority in reducing nausea and vomiting.%目的 观察多西他赛联合奈达铂诱导化疗序贯奈达铂单药同期放化疗治疗局部晚期鼻咽癌的近期疗效及不良反应.方法 经组织病理学确诊的局部晚期鼻咽癌患者60例,随机分为治疗组和对照组各30例.治疗组先行2个疗程多西他赛联合奈达铂诱导化疗,对照组先行2个疗程顺铂联合氟尿嘧啶(5-Fu)诱导化疗,3周重复.第7周开始放疗,放疗第1天同时行奈达铂或顺铂单药同期化疗,每周重复.放疗采用调强适形放射治疗(IMRT)技术.处方剂量:鼻咽大体肿瘤靶区68 ～ 70 Gy,颈部淋巴结大体肿瘤靶区66 ～ 68 Gy,临床靶区1 60～ 64 Gy,临床靶区2 50～ 54 Gy,每周5次,共30次.结果 治疗组和对照组的平均化疗周期数分别为7.67和7.17个(t=2.574,P＜0.05).诱导化疗后治疗组鼻咽大体肿瘤靶区(GTVnx)体积缩小了15.44 cm3(30.27％),对照组缩小了12.21 cm3(24.75％) (P＞0.05)；治疗组颈部淋巴结大体肿瘤靶区(GTVnd)体积缩小了8.97 cm3(52.64％),对照组缩小6.74 cm3(36.16％) (P＞0.05).治疗结束3个月后两组近期疗效差异无统计学意义(P＞0.05).治疗组和对照组的Ⅲ～Ⅳ度中性粒细胞减少的发生率分别为33.3％和10.0％ (t=4.812,P＜0.05)；Ⅲ～Ⅳ度恶心/食欲减退发生率分别为6.7％和30.0％(t=5.455,P＜0.05)；Ⅲ～Ⅳ度呕吐的发生率分别为0.0％和26.7％(t=7.067,P＜0.01).两组1年总生存率差异均无统计学意义(P＞0.05).结论 多西他赛联合奈达铂诱导化疗序贯奈达铂单药同期放化疗是治疗局部晚期鼻咽癌的可行方案,而恶心和呕吐等胃肠反应较轻,患者可耐受.
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