局部晚期鼻咽癌诱导化疗联合同期放化疗的临床观察  

Inductive chemotherapy followed by chemoradiotherapy forlocally advanced nasopharyngeal carcinoma

作　　者：黄素宁[1] 王仁生[1] 梁菲菲[1] 杜清华[1] 

机构地区：[1]广西医科大学第一附属医院放疗科,广西南宁530021

出　　处：《中华肿瘤防治杂志》2013年第8期614-617,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:研究TP和PF方案诱导化疗联合同期放化治疗局部晚期鼻咽癌的疗效及毒副作用。方法:经组织病理学确诊的局部晚期鼻咽癌患者80例,随机平分为TP组(多西他赛联合顺铂)和PF组(顺铂联合5-FU)。TP组先行2个周期多西他赛联合顺铂诱导化疗,PF组先行2个周期顺铂联合5-FU诱导化疗,3周重复。第7周开始放疗,放疗同期行顺铂单药化疗,3周重复。放疗采用调强适形放射治疗(IMRT)。处方剂量:PTVnx68～72Gy,PTVnd66～70Gy,PTV160～64Gy,PTV250～54Gy,5次/周,共30次。结果:TP组GTVnx体积缩小(15.32±4.18)cm3,PF组缩小(14.11±3.98)cm3,P>0.05;TP组GTVnd体积缩小(10.67±2.02)cm3,PF组缩小(8.95±2.44)cm3,P>0.05。治疗结束3个月后两组近期疗效对比差异均无统计学意义,P>0.05。TP和PF组的Ⅲ～Ⅳ度白细胞减少的发生率分别为37.5%和10.0%,P=0.003 8;Ⅲ～Ⅳ级口腔黏膜反应的发生率分别为7.5%和27.5%,P=0.001 9;Ⅲ～Ⅳ度恶心、呕吐/食欲减退发生率两组比较差异均无统计学意义,P>0.05。两组1、2年总生存率分别为100.0%、87.5%和100.0%、82.5%,差异均无统计学意义,P>0.05。结论:TP诱导化疗联合同期放化疗是治疗局部晚期鼻咽癌的有效方案,近期疗效较好,毒副作用轻,尤其是口腔黏膜反应较PF组轻,患者耐受性好。OBJECTIVE：To compare the efficacy, side reaction between TP and PF induction chemotherapy followed by concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma（NPC）. METHODS： Eighty patients with locally advanced nasopharyngeal carcinoma confirmed by histopathological diagnosis were randomized into TP group and PF group. The patients in TP group received two cycles of induction chemotherapy with docetaxel plus cisplatin, whereas the patients in PF received two cycles of induction chemotherapy with cisplatin plus 5-fIuorouracil, then all patients followed by concurrent chemoradiotherapy with cisplatin chemotherapy,every 3 weeks. All the patients received intensity modulated radiotherapy （IMRT） which began at the 7th week. The prescription doses were as follows..PTVnx 68- 72 Gy, PTVnd 66- 70 Gy, PTV1 60 -64 Gy, PTV2 50 - 54 Gy, 5 fraction/w, 30 fraction. RESULTS.. The volume of GTVnx of TP group and PF group reduced by （15.32±4.18） cm3 and （14. 11±3. 98） cm3 after induction chemotherapy,respectively（P%0. 05）. The volume of GTVnx of TP group and PF group reduced by （10. 67±2.02） cm3 and （8. 95±2. 44） cm3 ,respectively （P〉0.05）. There was no significant difference in recent curative effect between the two groups （P〉0. 05）. More grade 3-4 neutropenia occurred in TP group than that in PF group （37. 5% vs 10.0% ,P〉0.003 8）. Less grade 3-4 oral mucosa reaction rate occurred in TP group than that in PF group （7.5%vs 27.5% ,P=0. 001 9）. There was no significant difference in nausea and vomiting between the two groups. There were no significant difference in one-year survival rate and two-year survival between the two groups （P〉0. 05）. CONCLUSION： TP induction chemotherapy combined concurrent chemoradiotherapy is the effective scheme for treatment of locally advanced nasopharyngeal carcinoma, and has good recent curative effect and mild side reaction,especially for oral mucosa reaction it has better tolerance for patients.

关 键 词：鼻咽肿瘤 诱导化疗 同期放化疗 多西他赛 药物疗法 联合 

分 类 号：R739.63[医药卫生—肿瘤]