摘要目的 对比奈达铂与顺铂为基础的化疗联合调强适形放疗(IMRT)治疗非高发区局部晚期鼻咽癌的疗效及不良反应.方法 回顾性分析2014年1月至2016年7月初治的行根治性放疗的Ⅲ～ⅣB期鼻咽癌患者,筛选出62对患者(奈达铂组和顺铂组各62例)进行配对分析.奈达铂组采用奈达铂3周方案同期化疗2～3个疗程,序贯奈达铂+氟尿嘧啶方案辅助化疗2～3个疗程.顺铂组采用顺铂3周方案同期化疗2～3个疗程,序贯顺铂+氟尿嘧啶方案辅助化疗2～3个疗程.比较两组患者各项生存率及急性不良反应.结果 奈达铂组和顺铂组的2年总生存率(OS)分别为89.9％ 和91.1％,无局部复发生存率(LRFS)为90.5％和93.5％,无区域复发生存率(RRFS)为96.4％ 和96.0％,无远处转移生存率(DMFS)为85.9％ 和90.3％,差异均无统计学意义(P>0.05).急性不良反应方面,同期放化疗及辅助化疗期间,奈达铂组3～4级呕吐发生率均较顺铂组明显降低,辅助化疗期间,奈达铂组3～4级血小板减少的发生率较顺铂组明显升高.结论 对于非高发区局部晚期鼻咽癌患者,以奈达铂为基础的化疗联合IMRT2年各项生存率与顺铂组相似,且3～4级呕吐发生率较顺铂组明显降低.对于无法耐受顺铂治疗的患者,奈达铂也许可作为替代化疗方案.

abstractsObjective To compare the efficacy and toxicity of nedaplatin and cispaltin chemotherapy combined with intensity modulated radiotherpy ( IMRT) in the treatment of locally advanced nasopharygeal carcinoma (NPC) patients in unendemic area. Methods From January 2014 to July 2016, sixty-two pairs of patients with stageⅢ-ⅣB NPC patients who underwent radical radiotherapy were selected for pair analysis (nedaplatin group and cisplatin group, 62 cases for each group). The nedaplatin group was treated with IMRT concurrent with nedaplatin at a dose of 100 mg/m2 every three-weeks for 2 -3 cycles, and sequential adjuvant chemotherapy of nedaplatin + fluorouracil regimen for 2 to 3 courses. The cisplatin group was treated with IMRT concurrent with cisplatin at a dose of 80 mg/m2 every three-weeks for 2-3 cycles, and sequential adjuvant chemotherapy of cisplatin + fluorouracil regimen for 2 to 3 courses. Results The 2-year overall survival ( OS ) of nedaplatin group and cisplatin group was 89. 9％ and 91. 1％, local recurrence free survival ( LRFS ) 90. 5％ and 93. 5％, regional recurrence free survival ( RRFS ) 96. 4％ and 96. 0％, and distant metastasis free survival ( DMFS ) 85. 9％ and 90. 3％, respectively. There were no significant differences between nedaplatin group and cisplatin group ( P >0. 05 ) . In the occurrence of acute toxicity, during concurrent chemoradiotherapy and adjuvant chemotherapy, the incidence of grade 3-4 vomiting in nedaplatin group was significantly lower than that in cisplatin group. During adjuvant chemotherapy, the incidence of grade 3 - 4 thrombocytopenia in nedaplatin group was significantly higher than that in cisplatin group. Conclusions For NPC patients with stage Ⅲ-ⅣB in unendemic area, the 2-year survival rates of nedaplatin group was silimiar to cisplatin group, while the incidence of grade 3 -4 vomiting was significantly lower than that in cisplatin group. Nedaplatin maybe an alternative chemotherapy for patients who cannot tolerate cisplatin chemotherapy.