局部晚期鼻咽癌吉西他滨同步放化疗的临床观察  

Concurrent radiotherapy and gemcitabine for locally advanced nasopharyngeal carcinoma

作　　者：谢松喜[1] 李伟雄[1] 张红丹[1] 陈应瑞[1] 

机构地区：[1]广东省人民医院肿瘤中心放疗科,广东广州510080

出　　处：《中华肿瘤防治杂志》2009年第6期454-456,共3页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:为了探讨局部晚期鼻咽癌吉西他滨同步放化疗的毒性和疗效。方法:确定吉西他滨的最佳使用剂量,选择病理确诊的局部晚期鼻咽癌患者60例,包括T3、T4和N2、N3患者。吉西他滨分为100、50和30mg/m23个剂量,每个剂量级别至少3例患者进入研究。每周一进行吉西他滨同步放化疗,化疗结束后至少4h行放疗,同步化疗共6次,放射治疗5次/周,2Gy/次,鼻咽部总剂量70～72Gy,颈淋巴结转移灶70Gy。结果:100mg/m2剂量级别入组15例患者,4级放射性口腔黏膜炎发生率53.3%(8/15),3级放射性皮炎33.3%(5/15);50mg/m2剂量级别25例患者,4级放射性口腔黏膜炎12%(3/25),3级放射性口腔黏膜炎40%(10/25);30mg/m2剂量级别20例患者,3级放射性口腔黏膜炎40%(8/20)。60例患者中完全缓解率41.7%(25/60),部分缓解率50.0%(30/60),稳定8.3%(5/60)。1年局部控制率100%。结论:局部晚期鼻咽癌采用吉西他滨同步放化疗的最大耐受剂量为100mg/m2,推荐最佳剂量为50mg/m2,主要的毒性为放射性口腔黏膜炎和放射性皮炎,近期疗效令人鼓舞。OBJECTIVE：To preliminarily assess the efficacy and toxicity of concurrent radiotherapy and weekly gemcitabine for locally advanced nasopharyngeal carcinoma and to confirm the optimum dose of gemcitabine. METHODS： Sixty patients with nasopharyngeal carcinoma of stage Ⅲ and ⅣA including T3,T4 and N2,N3 were enrolled. Gemcitabine doses were divided to three dose levels： 100 mg/m^2, 50 mg/m^2 and 30 mg/m^2, respectively, and at least 3 patients were enrolled in each cohort. Gemcitabine was administrated intravenously over 30 minutes once weekly, and at least 4 hours before radiation for 6 weekly cycles. The nasopharyngeal region received 70-72 Gy and neck positive lymph node regions received 70 Gy, which were delivered by a conventionally fractionated schedule （2 Gy per fraction, 5 fractions per week）. Sixty patients had completed radiochemotherapy. RESULTS： In the 100 mg/m^2 dose cohort there were 8 of 15 patients （53.3%,8/15） experienced grade 4 mucositis and grade 3 dermatitis for 5 patients （33.3%,5/15）; 25 patients were enrolled in the 50 mg/m^2 dose cohort, 3 patients suffered from the grade 4 mucositis and 10 patients for grade 3 mucositis （40%,10/25）; 8 patienst with grade 3 mucositis were observed in the 30 mg/m^2 dose cohort of 20 patients （40%,8/20）. Twenty-five patients achieved complete response （41.7%,25/60）, 30 patients were classed with partial response （50.0%,30/60） and 5 patients obtained stable disease （8.3%,5/60）. At a median follow-up of 26 months the 1-year locoregional progression-free was 100%. CONCLUSIONS： The maximum tolerated dose of gemcitabine concurrent with radiation for locally advanced nasopharyngeal carcinoma is 100 mg/m^2 and the optimum dose is 50 mg/m^2. The major toxicities ane radiation-induced mucositis and dermatitis, but the preliminary result is promising.

关 键 词：鼻咽肿瘤/放射疗法 鼻咽肿瘤/药物疗法 综合疗法 

分 类 号：R739.63[医药卫生—肿瘤]