关键词: 鼻咽癌, 诱导化疗, 调强放疗, 辅助化疗, 临床疗效

Abstract: Background and purpose: The efficacy of induction chemotherapy (IC) combined with intensitymodulated radiotherapy (IMRT) and adjuvant chemotherapy (AC) for nasopharyngeal carcinoma (NPC) remains unclear. This study aimed to compare the clinical outcomes of GP (gemcitabine plus cisplatin) regimen, PF (cisplatin and 5-FU) regimen and TPF (docetaxel, cisplatin and 5-FU) regimen combined with IMRT in patients with nonmetastatic NPC. Methods: This study retrospectively analyzed 134 patients with non-metastatic NPC who received IC combined with IMRT and AC in Department of Radiation Oncology, Fudan University Shanghai Cancer Center from Jan. 2009 to Dec. 2010. Group GP (gemcitabine 1 000 mg/m² on day 1 and 8, and cisplatin 25 mg/m² on days 1-3), group PF (cisplatin 25mg/m² on days 1-3, and 5-FU 500 mg/m² on days 1-5 with continuous infusion) and TPF group (docetaxel 75 mg/m² on day 1, cisplatin 25 mg/m² on day 1-3, and 5-FU 500 mg/m² on days 1-5 with continuous infusion) enrolled 55, 20 and 59 patients, respectively. IMRT was delivered after 2-3 cycles of IC with a 21-day interval. The prescribed doses of gross tumor volume (GTV) for primary tumor and positive lymph nodes were (66.0-70.4) Gy/(30-32) F and 66.0 Gy/(30-32) F, respectively. Two to three cycles of AC were administered 28 days after completion of radiotherapy with the same regimen as IC. The 5-year overall survival (OS), disease-free survival (DFS) and local recurrence-free survival (LRFS) rates in the three groups were evaluated. Results: The 5-year OS rates of group GP, group PF and group TPF were 91.9%, 75.1% and 90.8%, respectively. The 5-year LRFS rates were 95.8%, 82.3%, and 96%, respectively. The 5-year OS (P=0.041) in group GP was higher than that in PF group. The 5-year LRFS rate in group TPF was higher than that in group PF (P=0.043). There was no significant difference in survival curves between group TPF and group GP. Conclusion: The clinical efficacy of GP regimen combined with IMRT and AC for the treatment of non-metastatic nasopharyngeal carcinoma may be better than that of PF regimen, and verification of large sample data is needed. The three drugs combined TPF regimen is not superior to the GP scheme. Phase Ⅲ clinical trial to evaluate the efficacy of GP regimen in patients with non-metastatic nasopharyngeal carcinoma could be considered.

Key words: Nasopharyngeal carcinoma, Induction chemotherapy, Intensity-modulated radiotherapy, Adjuvant chemotherapy, Clinical efficacy