TPF诱导化疗序贯同步放化疗治疗初治远处转移鼻咽癌的临床分析  

Clinical analysis of TPF neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in the treatment of nasopharyngeal carcinoma patients with distant metastasis at preliminary diagnosis

作　　者：毛振华[1,2] 金风[1,2] 吴伟莉[2] 李媛媛[2] 龙金华[2] 龚修云[2] 陈潇潇[2] 李卓玲[2] 毕婷[2] 贺前勇 瞿波[2] 

机构地区：[1]贵阳医学院,贵州贵阳550004 [2]贵阳医学院附属医院肿瘤科,贵州省肿瘤医院头颈肿瘤科,贵州贵阳550004

出　　处：《现代肿瘤医学》2015年第7期916-921,共6页Journal of Modern Oncology

基　　金：贵州省科技厅社发攻关联合基金项目[编号:黔科合LG字(2012)065号]

摘　　要：目的:研究TPF(多西他赛+顺铂+5-氟尿嘧啶)方案诱导化疗联合调强放疗治疗初治远处转移鼻咽癌的毒性和近期疗效。方法:初治的远处转移鼻咽癌患者,接受诱导化疗TPF方案,多西他赛:75mg/m2,静滴,d1;顺铂:75mg/m2,静滴或泵注,d1或d1-5;5-氟尿嘧啶:750mg/(m2·d),持续静滴,d1-5,21d/周期,共2-3周期。诱导化疗后评价有效者行三维适形调强放疗(IMRT),同期行顺铂单药增敏化疗(顺铂100mg/m2,静滴,d1-d2,21d/周期,共2周期)。放化疗结束1个月后行辅助化疗,方案及方法同诱导化疗,共2周期。不良反应按CT-CAEv3.0评价分级,临床疗效参照2000年实体瘤治疗疗效评价标准(RECIST)进行评价,有效率为CR+PR。结果:诱导化疗后鼻咽部有效率83.8%,颈部淋巴结有效率77.4%,远处转移靶病灶有效率33.3%。诱导化疗序贯同步放化疗后鼻咽部有效率92.3%,颈部淋巴结有效率100%,远处转移靶病灶有效率30.0%。诱导化疗的主要不良反应为骨髓抑制及消化道毒性,III级以上粒细胞下降为22.6%,III级呕吐为3.0%。同期放化疗期间口腔黏膜反应最多见为89.3%,其中17.9%出现III-IV级反应。无治疗相关死亡。结论:TPF方案诱导化疗联合顺铂同期调强放化疗治疗初治远处转移鼻咽癌安全、近期疗效好,远期疗效及不良反应尚需扩大病例数及继续随访。Objective： To investigate short- term efficacy and toxicity of induction chemotherapy including docetaxel（ TXT）,cisplatin（ DDP）,and 5 fluorouracil（ 5- FU） followed by concomitant chemoradiotherapy in the treatment of nasopharyngeal carcinoma（ NPC） patients with distant metastasis at preliminary diagnosis. Methods：Newly diagnosed metastatic NPC patients were enrolled,all patients received a total of two cycles or three cycles of TPF regimen. The TPF chemotherapy regimen was administered as follows： TXT,75 mg / m2,infusion,d1; cisplatin,75 mg / m2,infusion,d1 or d1- 5; 5- fluorouracil,750mg/（ m2·d）,bolus infusion,d1- 5,with 21 days each cycle. And those patients who could obtain efficacy via induction chemotherapy,would be provided with intensity- modulated radiotherapy as a concurrent radiotherapy and chemotherapy（ cisplatin 100 mg / m2,infusion,d1- 2,with 21 days each cycle and a total of 2 courses）. Additionally,a month after the chemotherapy,an adjuvant chemotherapy,with the same scheme as that of induction chemotherapy,a total of 2 courses. Acute and late toxicities were graded according to the Common Terminology Criteria for Adverse Events v3. 0 scoring criteria. Tumor response was evaluated using 2000 Response Evaluation Criteria in Solid Tumors criteria. Results： The effective rate of nasopharynx,cervical lymph node and distant metastasis target lesions after induction chemotherapy were 83. 8%,77. 4% and 33. 3%,respectively.Whereas the effective rate of nasopharynx,cervical lymph node and distant metastasis target lesions of the combined modality treatment were 92. 3%,100% and 30. 0%,respectively. The main side effects from induction chemotherapy include an over grade III granulocytopenia of 22. 6%,grade III nausea and vomiting accounted for 3%. Major toxicity from concurrent chemo- radiotherapy was oral mucositis（ 89. 3%）; grade III to IV oral mucositis was 17. 9%. No treatment- related deaths occurred in this study. Conclusion： Induction chrono- chemotherapy using TP

关 键 词：鼻咽癌 诱导化疗 适形调强放射治疗 同期放化疗 

分 类 号：R730.5[医药卫生—肿瘤] R739.63[医药卫生—临床医学]