局部晚期鼻咽癌TPF方案诱导化疗加紫杉醇或顺铂同期IMRT疗效分析  

Efficacy of induction chemotherapy with TPF plus concurrent IMRT with paclitaxel or cisplatin in treatment of locally advanced nasopharyngeal carcinoma

作　　者：麻发强[1,2] 金风[2] 吴伟莉[2] 李媛媛[2] 龙金华[2] 陆方阳[1] 毕婷[2] 李卓玲[2] 贺前勇 瞿波[2] 

机构地区：[1]贵阳医学院第二附属医院肿瘤科,凯里556000 [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,贵阳550004

出　　处：《中华放射肿瘤学杂志》2015年第3期290-294,共5页Chinese Journal of Radiation Oncology

基　　金：贵州省科技厅社发公关联合基金项目（黔科合LG字[2012]065号）;贵阳市社会发展与民生科技计翅I项目（筑科合同[2013103]29号）;贵州省科技厅社会发展公共关系联合基金项目（黔科合LG字[2012]072号）

摘　　要：目的 分析局部晚期鼻咽癌TPF诱导化疗加紫杉醇或顺铂同期IMRT的疗效.方法 2008-2012年间263例局部晚期鼻咽癌患者入组研究.鼻咽原发病灶、阳性淋巴结处方剂量69.96-73.92 Gyfen 33次,CTV处方剂量60.06 Gy分33次,淋巴结阴性引流区50.96 Gy分25次.TPF（多西紫杉醇75 mg/m^2,顺铂75 mg/m^2,氟尿嘧啶750 mg/m^2·d^-1）诱导化疗2-3周期,128例用紫杉醇135 mg/m^2、135例用顺铂100 mg/m^2同期化疗第1、22天,共2周期.Kaplan-Meier计算生存率并Logrank法检验,Cox模型多因素预后分析.结果 5年样本量为42例.5年OS、PFS、LRFS、RRFS和DMFS分别为81.6％、76.1％、92.3％、88.5％和80.4％.顺铂同期比紫杉醇同期组有优势分别在OS（93.5％∶74.7％,P =0.035）、PFS （80.1％∶72.7％,P=0.034）、LRFS （95.9％∶ 88.8％,P =0.020）、DMFS （83.5％∶77.5％,P=0.033）.同期放化疗的≥3级白细胞下降、胃肠道反应、口腔黏膜炎和放射性皮炎发生率分别为33.1％、11.8％、26.3％和11.1％.1、2级口干50.3％、12.6％,3级听力下降和张口困难为3.4％和3.3％.结论 局部晚期鼻咽癌TPF诱导化疗加顺铂同期比加紫杉醇同期IMRT的OS、PFS、LRFS和DMFS高,急性不良反应可耐受.Objective To evaluate the efficacy of docetaxel,cisplatin,and 5-fluorouracil （TPF）-based induction chemotherapy plus concurrent intensity-modulated radiotherapy （IMRT） with paclitaxel or cisplatin in the treatment of locally advanced nasopharyngeal carcinoma （NPC）.Methods From 2008 to 2012,263 patients with locally advanced NPC were enrolled as subjects.A prescribed dose of 69.96-73.92 Gy in 33 fractions was applied to the primary nasopharyngeal gross tumor volume and the positive lymph nodes,60.06 Gy in 33 fractions to the clinical target volume,and 50.96 Gy in 25 fractions to the negative lymphatic drainage volume.All patients were treated with two or three cycles of TPF-based induction chemotherapy （docetaxel 75 mg/m^2;cisplatin 75 mg/m^2;5-fluorouracil 750 mg/m^2 · d^-1）,followed by two cycles of concurrent IMRT with paclitaxel （135 mg/m^2 on days 1 and 22） for 128 patients and with cisplatin （100 mg/m^2 on days 1 and 22） for 135 patients.The survival rates were calculated with the Kaplan-Meier method and analyzed by the log-rank test.Multivariate prognostic analysis was performed using the Cox regression model.Results With a sample size of 42 patients,the 5-year overall survival （OS）,progression-free survival （PFS）,local recurrence-free survival （LRFS）,regional recurrence-free survival （RRFS）,and distant metastasis-free survival （DMFS） were 81.6%,76.1%,92.3%,88.5%,and 80.4%,respectively.Patients treated with induction chemotherapy plus concurrent IMRT with cisplatin had significantly higher OS （93.5%vs.74.7%,P=0.035）,PFS （80.1% vs.72.7%,P=0.034）,LRFS （95.9% vs.88.8%,P =0.020）,and DMFS （83.5% vs.77.5%,P =0.033） than those treated with concurrent IMRT with paclitaxel.Due to concurrent chemoradiotherapy,the incidence rates of grade ≥ 3 leucopenia,gastrointestinal reactions,oral mucositis,and radiodermatitis were 33.1%,11.8%,26.3%,and 1 1.1%,respectively.The incidence rates of grade 1 xerostomia,grade 2 xerostomia,grade 3 hearing loss,and grade 3 tri

关 键 词：鼻咽肿瘤/调强放射疗法 鼻咽肿瘤/化学疗法 诱导化疗 同期放化疗法 预后 

分 类 号：R739.63[医药卫生—肿瘤]