两种不同给药速度的时辰化疗联合调强放疗治疗局部晚期鼻咽癌的临床研究  

An analysis on the combination of chrono-chemotherapy with different speed rate and concomitant intensity-modulated radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma

作　　者：万山 金风 吴伟莉 李媛媛 龙金华 陈国焱 甘家应 何志旭[1] 周建奖[1] 余芳 Wan Shah;Jin Feng;Wu Weili;Li Yuanyuan;Long Jinhua;Chen Guoyan;Gan Jiaying;He Zhixu;Zhou Jianjiang;Yu Fang(Guizhou Medical University, Guiyang 550001 , China;Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Chin;Department of Head and Neck Oncology, Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang 550004, Chin)

机构地区：[1]贵州医科大学,贵阳550001 [2]贵州医科大学附属医院肿瘤科,贵阳550001 [3]贵州医科大学附属肿瘤医院贵州省肿瘤医院头颈肿瘤科,贵阳550004

出　　处：《中华放射医学与防护杂志》2018年第4期278-284,共7页Chinese Journal of Radiological Medicine and Protection

基　　金：贵州省应用基础研究计划重大专项（黔科合J重大字[2015]2003）

摘　　要：目的 评估诱导化疗序贯时辰化疗正弦弧给药与匀速给药联合调强放疗在局部晚期鼻咽癌患者运用中的不良反应、即刻疗效及淋巴免疫功能的差异。方法 回顾性分析贵州省肿瘤医院所有经病理活检证实的初治Ⅲ~ⅣB期鼻咽癌患者70例，先给予2周期TPF方案诱导化疗。多西他赛75 mg/m2，静脉滴注，第1天，顺铂75 mg/m2，静脉滴注，第1天；5-氟尿嘧啶750 mg·m-2·d-1，第1~5天，持续静脉泵入，21 d/周期。随后同步放化疗期间正弦组顺铂以时辰化疗正弦曲线形式给药，而匀速组顺铂以时辰化疗匀速泵入给药，两组顺铂100 mg/m2，给药时间均为早上10点至晚上10点。每3周为1个周期，共2~3个周期。两组均联合调强放疗。鼻咽原发病灶（GTVnx）69.96~73.92 Gy/33次，计划靶区（PTVnx）69.96 Gy/33次，颈部转移淋巴结（GTVnd）69.96 Gy/33次，高危淋巴靶区（PTV1）60.06 Gy/33次，低危淋巴靶区（PTV2）50.96 Gy/28次。结果 诱导化疗序贯同步放化疗正弦组主要不良反应依次为白细胞降低、恶心、口腔黏膜反应、血红蛋白降低等；匀速组主要不良反应依次为血红蛋白降低、白细胞降低、恶心、口腔黏膜反应等，两组的不良反应差异均无统计学意义（P〉0.05）。治疗结束后，正弦组完全缓解（CR）11.4%、部分缓解（PR）85.7%、稳定（SD）2.9%、进展（PD）0、总有效率（ORR）97.1%；匀速组分别为22.9%、74.2%、2.9%、0、97.1%，且两组组间各疗效评价比较差异均无统计学意义（P〉0.05）。正弦组和匀速组患者2年总生存（OS）分别为：82.9%、94.3%；2年无进展生存率（PFS）分别为77.1%、91.4%；2年无远处转移生存率（DMFS）分别为82.9%、91.4%。治疗结束后正弦组免疫指标CD3＋较匀速组高，且差异有统计学意义（Z=3.254，P 〈 0.05）。结论 诱导化疗序贯同步时辰化疗正弦给药与匀速给药两组患者在不良反应、疗效Objective To evaluate the differences of toxicities,therapeutic efficacy and immune function between induction chemotherapy followed by sinusoidal chrono-modulated infusion and flat intermittent infusion of cisplatin（DDP）with intensity-modulated radiotherapy （IMRT） in patients with locoregionally advanced nasopharyngeal carcinoma （NPC）. Methods Seventy patients with biopsy-diagnosed stages Ⅲ and ⅣB NPC （according to the 2010 UICC staging system） were treated with two-cycle induction chemotherapy before chemoradiotherapy in Guizhou Cancer Hospital. The TPF chemotherapy regimen was administered as follows：The TXT and DDP with the dose of 75 mg/m2 was carried out by bolus infusing for the first day, the 5-FU with 750 mg·m-2·d-1 was carried out by continuous intravenous pumping for the first day to fifth day（120 h）. The induction chemotherapy was 21 days per cycle, for two cycles. After that all patients were randomly treated with 2-3 cycles of sinusoidal chrono-modulated infusion or flat intermittent constant rate infusion of DDP with IMRT. Using a multi-channel programmed pump, the patients were given 12 h continuous infusions of DDP （100 mg/m2） for day one, repeated every 3 weeks for 2-3 cycles. DDP was administered from 10：00 am to 10：00 pm. Concurrent radiotherapy regimen was administered as follows：GTVnx 69.96-73.92 Gy/33 f, PTVnx 69.96 Gy/33 f, PTVnd 69.96 Gy/33 f, PTV1 60.06 Gy/33 f, PTV2 50.96 Gy/28 f. Results The main toxicities of chemoradiotherapy in the group of sinusoidal chrono-modulated infusion were bone marrow suppression：leukocytes, and then nausea, oral mucositis and hemoglobin. The main toxicities of chemoradiotherapy in the group of flat intermittent constant rate infusion were bone marrow suppression：hemoglobin, leukocytes, and then nausea, oral mucositis. No significant differences were observed for toxicities（P〉0.05）. After concurrent chemoradiotherapy, the complete response rate （CR）, partial response rate （PR）, stable disease rate（SD

关 键 词：鼻咽癌 化疗方式 不良反应 疗效 免疫功能 

分 类 号：R739.63[医药卫生—肿瘤]