目的：探讨不同周期多西他赛联合顺铂、5-FU方案诱导化疗后同步放化疗对局部中晚期鼻咽癌的近期疗效及不良反应。方法178例局部中晚期鼻咽癌患者随机分为3周期诱导化疗联合同期放化疗组和2周期诱导化疗联合同期放化疗组。结果诱导化疗结束后，3周期、2周期诱导化疗联合同期放化疗组鼻咽原发病灶有效率分别为96.77%、91.76%；颈部淋巴结转移灶有效率均为100%；同期放化疗后评价，两组局部肿瘤控制率均为100%。3周期诱导化疗组、2周期诱导化疗组Ⅲ-Ⅳ度口腔黏膜反应分别占29%、27%，P>0.05，Ⅲ-Ⅳ度粒细胞减少分别占13%、14%，P>0.05，Ⅲ-Ⅳ度胃肠道反应分别占29%、31%，P>0.05；Ⅲ-Ⅳ度皮肤反应分别占11%、6%，P<0.05。结论鼻咽癌对DCF诱导化疗表现出高反应率，增加诱导化疗周期在局控率方面尚未表现出明显的优势，并未使同期放化疗毒性反应明显增加，远期疗效及慢性不良反应有待进一步观察。%Objective To investigate recent efficacy and adverse reactions after the different cycles of induction chemotherapy involved docetaxel ,cisplatin plus 5-FU followed by concurrent chemoradiotherapy of locally advanced nasopharyngeal carcinoma. Methods 178 cases of locally advanced nasopharyngeal carcinoma were randomly divided into two groups. One group was in-duced by three cycles of chemotherapy,another group was induced by two cycles,then two groups were followed by concurrent chemoradiotherapy. Results At the end of induction chemotherapy,the response rates of nasopharyngeal primary lesion were 96. 77%,91.76%respectively for three and two cycles induction chemotherapy plus concurrent chemotherapy ,the response rate of cer-vical lymph node metastases were all 100%. The local tumor control rates were all 100% after the end of concurrent chemoradio-therapy. The percentages of Ⅲ-Ⅳ oral mucositis were 29% and 27%,P>0.05,the percentages of Ⅲ-Ⅳ neutropenia were 13%and 14%,P>0.05,the percentages of Ⅲ-Ⅳgastrointestinal reactions were 29% and 31%,P>0.05,the percentages of Ⅲ-Ⅳskin reactions were 11% and 6%,P<0.05 respectively for three and two cycles induction chemotherapy plus concurrent chemotherapy. Conclusion DCF induction chemotherapy for nasopharyngeal carcinoma show a high response rate. Increased induction chemotherapy cycles in local control rates have not yet to show a clear advantage,and do not make concurrent chemoradiotherapy significantly increased toxicity,patient tolerance,better compliance.Long-term efficacy and chronic adverse reactions remains to be seen.
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