目的：鼻咽癌是一種好發於中國南方的癌症，傳統的治療方式是放射治療，其五年存活率約 50%，近年來癌症治療趨勢是合併式療，鼻咽癌對放射線和化學治療都很敏感，本研究探討同步放射化學治療對晚期鼻咽癌的之可行性、療效及副作用。材料與方法：本研究共收集 80 位晚期鼻咽癌，其中 76 例 (95%) 屬於第四期。 最初 19 例接受傳統式分次放射治療方式，即每天照射一次，每次 1.8-2.0 Gy，每週照射五次； 其次 61 例接受我們自行設計的部份高分次放射治療方式：第一、五、六週每天上下午各照一次 1.5 Gy， 第二、三、四週每天照射一次每次 1.8 Gy，總濟量為 72 Gy/45 分次 /6 週， 如果遇到假日或機器故障，則利用週六補照或將劑量分攤於其他治療日，務必於六週內給予 72 Gy。同步化學治療採用 cisplatin 和 5-FU，在放療中第一和第五週同時給予二次化療。 結果：80 例中有 77 例 (96%) 腫瘤完全緩解， 3 例腫瘤部份緩解佔 4%，腫瘤反應率高達 100%! 病人的急性副作用，主要是白血球降低、口腔黏膜發炎反應 (56% 達第三級 )、體重減輕... 等。 有 5 例第二次化療因毒性反應須延後一週給予，有 2 例第二次化療只打一半，有 2 例拒絕第二次化療。 放射治療因毒性反應中斷超過一週以上者有 7 例， 其中 1 例只照射至55.5 Gy 後，就拒絕繼續放療。迄今追蹤時間已 39 至 66 個月 (中值追蹤時間 48 個月 )，結果 23 例已死亡，57 人仍存活。 死亡病例中，17 例因鼻咽癌而死 (16 例死於遠處轉移 )，總計目前治療失敗者有 24 例， 單獨鼻咽部復發 3 例，鼻咽部和頸部淋巴同時復發者 4 例，1 例發生頸部淋巴復發合併遠處轉移， 其他 16 例都是遠處轉移，四年鼻咽部控制率 87.5%，頸部控制率 91.8%，遠處轉移控制率 76.2%，四年總存活率為 71.9%，四年無病存活率為 66.3%。結論：同步化學放射治療對晚期鼻咽癌是可行且很有效的治療方式，遠處轉移是治療失敗的主要原因，放療後再追加輔助性化學治療，以減少遠處轉移發生，提高存活率，值得進一步研究。

　　　　　Purpose: Nasopharyngeal carcinoma (NPC) is a radio- and chemosensitivetumor. We evaluate the feasibility, response and toxicities of concurrentchemoradiotherapy for advanced NPC. Materials and Methods: A total of 80patients with advanced NPC (95% belong to AJCC stage IV) were treated byconcurrent chemoradiotherapy. Radiotherapy was delivered using a telecobalt unitand 10 MV X-rays and by conventional fractionation (1.8-2.0 gy/fraction, 5fractions a week) for 19 patients and partially hperfractionated acceleratedschedule (1.5 Gy B.I.D. x 1 week + 1.8 Gy Q.D. x 3 weeks + 1.5 Gy B.I.D. x 2weeks) for 61 patients. Chemotherapy with cisplatin and 5-FU were givenconcurrently during the first and fifth weeks of radiotherapy. Results: Themajor toxicities were mucositis, leucopenia, weight loss, and skin reaction. the2nd cycle concurrent chemotherapy should be delayed for one week in 5 patients.Two patients refused the 2nd cycle chemotherapy and another 2 patients receivedincomplete dose of 2nd cycle chemotherapy. Seven patients interruptedradiotherapy for more than one week due to toxicities. One patient refusedfurther radiotherapy after 55.5 Gy. Complete response was noted in 77 cases(96%) and partial response 4%, with an overall response rate of 100%. After amedian follow-up time of 4 years (39-66 months), the nasopharynx disease-free,neck diseasefree, and distant metastasis disease-free survivals are 87.5%,91.8%, and 76.25 irrespectively. The 4-year overall survival and disease-freesurvival are 71.95 and 66.3%. Patients who failed were due to distantmetastases. Conclusion: Our data indicated that concurrent chemoradiotherapy foradvanced NPC is both feasible and effective, with acceptable toxicities.Post-radiation adjuvant chemotherapy to eradicate suclinical micrometastasisshould be further studied.