| Objective:Comparison long-term effect and toxicity of induction chemotherapy with docetaxel plus nedaplatin(DN) followed by nedaplatin concurrent chemoradiotherapy and induction chemotherapy with 5-fluorouracil plus cisplatin(PF) followed by cispla tin concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma.Methods:Retrospective analysis 146 cases locally advanced nasopharyngeal carcinoma with initial treatment in the First Affiliated Hospital Oncology department of Nanchang University,from June 2009 to December 2010. 82 patients received induction chemotherapy with docetaxel plus nedaplatin(DN) and 64 patients received induction chemotherapy with 5-fluorouracil plus cisplatin(PF). DN group:docetaxel75mg/m~2 d1 intravenous infusion,nedaplatin 80-100 mg/m~2 d1 intravenous infusion;every 3 weeks as a course of treatment. PF group:Cisplatin 30 mg/m~2 d1-3intravenous infusion,5-fluorouracil 500-800 mg/m~2 d1-5 intravenous infusion;every3 weeks as a course of treatment. DN group and the PF group received induction chemotherapy 2 courses.Induction chemotherapy followed by concurrent chemoradiotherapy. DN group: nedaplatin 40 mg/m~2 concurrent with radiotherapy every weeks,PF group:cisplatin 40 mg/m~2 concurrent with radiotherapy every weeks.All patients were received IMRT,Primary tumor?Metastatic cervical lymph nodes?Nasopharyngeal subclinical high-risk areas ? Nasopharyngeal subclinical low-risk areas ? Cervical prevention radiation areas : prescription dose of irradiation were66-70 Gy, 62-70 Gy, 60 Gy,54Gy and 54 Gy,treatment is divided into 30 times,one time a day,five times per week.Results:DN group and PF group 5-year Over survival rates were 65.8% and 64.0%(P =0.732),5-year Progress free survival rates were 64.6% and 60.9%(P = 0.761),5-year Locoregional failure free survival rates were 90.2% and 87.5%(P = 0.557),5-year Distant failure free survival was 73.1% and 71.8%(P = 0.916), there was no statistical significance. Chemotherapy related acute toxicity,DN group significantly higher than PF group in ?/? grade leukopenia were 36.5% and 20.3%(P = 0.032)??/? grade neutropenia were 30.4% and 9.3%(P = 0.002),There were significant differences. PF group was significantly higher than DN group in vomiting reaction,PF group had ?/? grade vomiting was 14%,DN group did not(P <0.001),There were significant differences. Thrombocytopenia and anemia occurred in both groups was similar(12.1% vs9.3%, P = 0.682; 18.2% vs17.1%, P = 0.992),there was no statistically significant. Radiation related acute toxicity, patients in both groups appear ?/ ? grade oral mucositis and skin reactions.DN group and PF group ?/ ? grade oral mucositis rate was 31.7% and 29.6%(P = 0.640), ? /? grade oral mucositis rate was 32.9% and 37.5%(P=0.565),there was no statistically significant.DN group and PF group ?/ ? grade skin reactions were 9.7% and 10.9%(P = 0.861)??/? grade skin reactions were 25.6% and 26.5%( P=0.896), there was no statistically significant. Radiation related late toxicity,there have higher incidence of ear and salivary gland damage, the radiation encephalopathy and radiation tissue fibrosis occurrence proportion were lower,radiation myelopathy no apparent,DN group and PF group ?/ ? grade ear radiation damage were 19.5% and 15.6%(P =0.542), ?/ ? grade salivary gland damage were 65.8% and 68.7%(P = 0.712), ?/ ? grade encephalopathy radiation damage 1.2% and 1.5%(P = 1.000), ?/ ? grade radiation tissue fibrosis incidence was 4.8% and 4.6%(P = 1.000),No ?/? grade reactions,there was no statistically significant.Conclusion:long-term effect of induction chemotherapy with docetaxel plus nedaplatin followed by nedaplatin concurrent chemoradiotherapy and induction chemotherapy with 5-fluorouracil plus cisplatin followed by cisplatin concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma have similar results. In terms of toxicity,PF group was significantly higher than DN group in vomiting reaction,but lower than DN group in bone marrow toxicity,Acute and late radiation damage were similar. |
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