鼻咽癌诊疗规范(第一版)

鼻咽癌诊疗规范（第一版）

郴州市第一人民医院肿瘤委员会

郴州市第一人民医院南院肿瘤五区（鼻咽癌中心）

2016年6月

执笔(按姓氏笔画排序) 成浩黄朝刚史俊文

专家组成员(按姓氏笔画排序) 成浩黄朝刚潘桂华任益民史俊文张宜生

1、分期标准采用鼻咽癌2008年分期系统及2010年AJCC第7版分期系统

2、治疗原则参考头颈部鳞癌综合治疗：中国专家共识2013版及2015版NCCN

Guidelines Head and Neck Cancer

3、T1-T2N0M0采用单纯根治性放疗

4、T1N1-3M0；T2-4NxM0采用同步放化疗+辅助化疗（2A类）或者诱导化疗1-2程+同步放化疗+辅助化疗（3类）或者单纯同步放化疗（2B类）

5、TxNxM1采用化疗4-6疗程，完全缓解行原发灶及颈部的根治性放疗；不完全缓解行原发灶及颈部的姑息性放疗

6、可切除的局部复发肿瘤，推荐手术切除，术后考虑加再次放疗±化疗。如果复发肿瘤不可切除，采用再次放疗±同步化疗，治疗结束后行联合化疗。方案：1）顺铂/卡铂+多西他赛/紫杉醇 2）顺铂/5-FU 3)西妥昔单抗/卡铂。对于不适合行根治性放疗或手术的患者，治疗原则同转移性鼻咽癌，对于合适的患者可推荐参与再放疗的临床试验。

诱导化疗方案：1、多西他赛或者紫杉醇+顺铂+5氟尿嘧啶方案。2、多西他赛或者紫杉醇+顺铂方案（2B类）。3、顺铂+5氟尿嘧啶方案（PF方案）。4、顺铂+表阿霉素+紫杉醇方案

同期化疗：推荐DDP 80-100 mg /m2,每3周一次。

，5-Fu 辅助化疗：1、顺铂+5氟尿嘧啶方案（PF方案）。DDP 80-100 mg /m2 d

1

（静脉滴注或持续静脉输注）。2、卡铂+5氟尿嘧啶方案（2B 600-750mg/m2 d

1-5

类）。3、多西他赛或者紫杉醇+顺铂或者卡铂方案。4、口服化疗：卡培他滨、替吉奥及替加氟。

鼻咽癌进展可改用化疗：1、卡铂+西妥昔单抗方案。2、顺铂+吉西他滨方案。3、

吉西他滨+长春瑞滨方案。4、口服化疗：卡培他滨、替吉奥及替加氟。

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