重组人粒-巨噬细胞集落刺激因子漱口液预防和治疗局部晚期鼻咽癌同步放化疗所致口腔黏膜炎  

Recombinant human granulocyte macrophage colony-stimulating factor for the prevention and treatment of oral mucositis induced by concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma

作　　者：包兴[1] 白明华[1] 王中卫[1] 康华峰[1] 张扬[1] Bao Xing, Bai Minghua, Wang Zhongwei, Kang Huafeng, Zhang Yang(Department of Oncology, the Second Affiliated Hospital of Xi＇an Jiaotong University, Xi＇an 710004, Chin)

机构地区：[1]西安交通大学第二附属医院肿瘤科,710004

出　　处：《肿瘤研究与临床》2018年第3期184-189,共6页Cancer Research and Clinic

摘　　要：目的观察重组人粒-巨噬细胞集落刺激因子（rhGM-CSF）漱口液预防和治疗局部晚期鼻咽癌同期放化疗所致口腔黏膜炎的临床效果。方法选择2015年4月至2017年4月西安交通大学第二附属医院肿瘤科治疗的64例局部晚期鼻咽癌患者，根据随机数字表法分为观察组和对照组，每组各32例，均采用调强放疗（IMRT），并同步TP方案（多西紫杉醇＋顺铂）化疗2个周期。两组患者均于放疗开始时使用漱口液防治口腔黏膜炎，观察组给予rhGM-CSF漱口液，对照组给予复方硼砂漱口液。采用美国放射肿瘤治疗协作组（RTOG）口腔黏膜炎分级标准和视觉模拟评分法（VAS）疼痛分级标准，评价两组患者在治疗中及治疗结束时口腔黏膜炎以及口腔疼痛的发生情况，并记录两组患者口腔黏膜炎开始出现的时间以及放疗总时间。结果所有患者均完成了同步放化疗计划，观察组总放疗时间[（46.4±1.6）d]短于对照组[（48.2±3.2）d]，差异有统计学意义（t=-2.720，P=0.009）。观察组和对照组的临床总有效率分别为93.8%（30/32）和96.9%（31/32），差异无统计学意义（χ2=0.35，P=0.554）。观察组发生1、2、3级口腔黏膜炎的平均时间分别为（20.9±2.5）、（29.3±2.4）、（34.5±1.8）d，晚于对照组的（16.3±2.0）、（24.2±2.2）、（31.0±2.2）d，差异均有统计学意义（t=8.125，P=0.000；t=8.840，P=0.000；t=6.944，P=0.001）。观察组在同步放化疗过程中3级口腔黏膜炎的发生率为31.2%（10/32），低于对照组的56.2%（18/32），差异有统计学意义（Z=-2.197，P=0.028），观察组在同步放化疗结束时2、3级口腔黏膜炎的总发生率为53.1%（17/32），低于对照组的81.2%（26/32），差异有统计学意义（Z=-2.708，P=0.007）。观察组口腔黏膜炎引起的中、重度口腔疼痛的发生率分别为46.9%（15/32）和6.2%（2/32），低于对照组的59.4%（19/32）和15.6%ObjectiveTo observe the effect of recombinant human granulocyte-macrophage colony-stimulating factor （rhGM-CSF） on the prevention and treatment of oral mucositis induced by concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma.MethodsA total of 64 patients with locally advanced nasopharyngeal carcinoma from April 2015 to April 2017 in the Second Affiliated Hospital of Xi＇an Jiaotong University were enrolled. The patients were randomly divided into the observation group （32 cases） and the control group （32 cases） according to the random number table method. Both groups were treated with intensity modulated radiotherapy （IMRT） and synchronized with TP regimen （docetaxel ＋ cisplatin） chemotherapy for 2 cycles. Both groups were treated with mouthwash at the beginning of radiotherapy to prevent oral mucositis. The observation group was given rhGM-CSF mouthwash, and the control group was given compound borax mouthwash. The oral mucositis and the oral pain during the treatment and the end of the treatment were evaluated by using American Radiation Oncology Group （RTOG）grading criteria and visual analogue scoring method （VAS） grading criteria. The time of onset of oral mucositis and the total time of radiotherapy in both groups was also recorded.ResultsAll the patients were treated with concurrent chemoradiotherapy. The total radiotherapy time in the observation group was less than that in the control group [（46.4±1.6） vs. （48.2±3.2） d, t=-2.720, P=0.009]. The clinical total effective rate was 93.8% （30/32） in the observation group and 96.9% （31/32） in the control group respectively （χ 2=0.35, P = 0.554）. The occurrence of grade 1, 2 and 3 oral mucositis in the observation group was （20.9±2.5）, （29.3±2.4）, and （34.5±1.8） d respectively, which was latter than that in the control group [（16.3±2.0）, （24.2±2.2） and （31.0±2.2） d] respectively （t = 8.125, P = 0.000; t = 8.840, P = 0.000; t = 6.944, P = 0.001

关 键 词：鼻咽肿瘤 放射疗法 抗肿瘤联合化疗方案 口炎 粒细胞巨噬细胞集落刺激因子 重组 

分 类 号：R739.63[医药卫生—肿瘤] R781.5[医药卫生—临床医学]