目的：探討晚期鼻咽癌患者接受誘導化療合併標靶治療，隨後接受強度調控放療的療效和毒性。 材料和方法：本研究收錄新診斷的第三、四期鼻咽癌患者 25 名，接受誘導化療合併標靶治療， 隨後進行強度調控放療。誘導化療為 P-FL 二藥聯合處方（順鉑加5- 氟尿嘧啶，17 例）、或三藥 聯合處方 P-FL-G（P-FL加健擇，7例）或 P-FL-D（P-FL加歐洲紫杉醇，一例），每週一種化藥 共給 10-12 週。在誘導化療期間同時給爾必得舒（Cetuximab）400 mg/m2 第 1 天，然後每週給 250 mg/m2。強度調控放療劑量為巨觀腫瘤體積給予 70 Gy/35 分次（T1-3 之病患），74 Gy/37 分 次或 76.8 Gy/64 分次（每次1.2 Gy，一天照射二次，T4腫瘤病患）。 結果：病人的中位數年齡為 44 歲；男性/ 女性= 19/6；病人一般狀況 ECOG 0/1=13/12；臨床分 期第三/ 四期= 12/13，病理類型（WHO分型）IIa/IIb = 12/13。所有患者對誘導化療合併標靶治 療耐受性良好。第 3 級毒性反應只有 8.0%白血球低下和 40.0%皮疹，沒有發生第 4 級毒性反 應。誘導化療合併標靶治療後，評估療效有 52.0%完全緩解率和 48.0％部分緩解率。24 例病患 於放射治療前，接受鼻咽腫瘤重切片，有 13 名（54.2%）病理報告無存活癌細胞。後續的強度 調控放療也進行順利，總治療天數介於 45-53 天（中位數 49 天）。經中位追蹤 21 個月後，有 四例發生遠處轉移，二年總存活率、原發及頸部無復發存活率、遠處轉移無復發存活率分別為 100%、100%、和 80%。 結論：誘導化療合併爾必得舒標靶治療，隨後強度調控放療，對晚期鼻咽癌是一種高度有效且 低毒性的治療方案。

Purpose : To investigate the efficacy and toxicity of induction bio-chemotherapy followed by intensity-modulated radiotherapy (IMRT) for advanced nasopharyngeal carcinoma (NPC) patients. Materials and Methods : Twenty-five patients with previously untreated, stage III/IV NPC received induction bio-chemotherapy followed by IMRT. Induction chemotherapy consists of weekly P-FL (cisplatin + 5-fluorouracil) doublet (n= 17) or a triplet of P-FL-G (P-FL + gemcitabine, n= 7) or P-FL-D (P-FL + docetaxel, n= 1) for a total of 10-12 weeks. Cetuximab 400 mg/m2 day 1, then 250 mg/m2 were administered every week. IMRT 70 Gy/35 fractions were delivered to T1-3 lesions and 74 Gy/37 fractions or 76.8 Gy/64 fractions to the T4 tumor. Results : Baseline characteristics are median age= 44 year-old; male/female= 19/6; performance status ECOG 0/1= 13/12; stage III/IV= 12/13, and pathological type (WHO) IIa/IIb= 12/13. All patients tolerated induction bio-chemotherapy very well. Grade 3 toxicity included leucopenia (8.0%) and skin rashes (40.0%). There was no grade 4 toxicity. After induction bio-chemotherapy, we obtained 52.0% complete response rate and 48.0% partial response rate. Thirteen of 24 (54.2%) patients who received re-biopsy of the nasopharynx before IMRT were reported as no viable tumor. IMRT was performed smoothly with a median treatment time of 49 days (range 45-53). After a median followup of 21 months, we observed 4 treatment failures, all in distant sites. The 2-year rates overall survival, locoregional failure-free and distant failure-free survivals were 100%, 100%, and 80%, respectively. Conclusion : Induction chemotherapy plus concurrent weekly cetuximab followed by IMRT is a highly effective protocol with very low toxicity in advanced NPC.