TPF方案诱导化疗鼻咽癌后Ⅲ~Ⅳ度骨髓抑制的临床分析  

Clinical analysis of gradeⅢ~Ⅳmyelosuppression after induction chemotherapy with docetaxel,cisplatin and 5-fluorouracil(TPF)in nasopharyngeal carcinoma

作　　者：蔡智谋 徐铭鸿 文忠[1] CHAI Zhimou;XU Minghong;WEN Zhong(Department of Otolaryngology,Zhujiang Hospital of Southern Medical University,Guangzhou 510282,China)

机构地区：[1]南方医科大学珠江医院耳鼻咽喉科,广东广州510282

出　　处：《中国耳鼻咽喉颅底外科杂志》2020年第3期312-317,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：广东省自然科学基金(S2011010003947)。

摘　　要：目的观察和分析顺铂联合多西他赛和氟尿嘧啶(TPF方案)在鼻咽部鳞状细胞癌的诱导化疗中出现Ⅲ~Ⅳ度骨髓抑制的临床特征和治疗策略。方法收集南方医科大学珠江医院接受TPF方案诱导化疗的186例首诊鼻咽癌患者临床资料,回顾性分析患者出现Ⅲ~Ⅳ度骨髓抑制情况及其波动规律,以期早期发现和治疗化疗后骨髓抑制。结果本组患者中有31例出现骨髓抑制,白细胞出现Ⅲ~Ⅳ度抑制时间为化疗后6~13 d,平均时间8.7 d;中性粒细胞抑制波动规律与白细胞相似,均呈“U”形波动,但出现时间要迟1~2 d,时间为化疗后7~14 d,平均时间10 d。结论TPF方案诱导化疗鼻咽癌出现骨髓抑制主要表现为白细胞减少伴随中性粒细胞下降,其波动规律呈“U”形改变;根据波动规律早期监测并治疗化疗后的骨髓抑制,及时予以升白细胞治疗可避免感染及严重毒副反应的发生,使鼻咽癌患者顺利进行TPF诱导化学治疗并如期行根治性放射治疗。Objective To observe and analyze the clinical features and treatment strategies of gradeⅢ~Ⅳmyelosuppression after induction chemotherapy with docetaxel,cisplatin and 5-fluorouracil(TPF)in nasopharyngeal carcinoma(NPC).Methods A total of 186 initially-diagnosed NPC patients received TPF induction chemotherapy in our hospital from^2016 to 2019 were collected.GradeⅢ~Ⅳmyelosuppression and its variation rule was analyzed retrospectively for early detection and treatment of myelosuppression after chemotherapy.Results Of all the 186 patients,myelosuppression occurred in 31.Leukocyte suppression of gradeⅢ~Ⅳappeared in 6 to 13 d after chemotherapy with an average of 8.7.The neutrophil suppression occurred 1 to 2 d later,in 7 to 14 d after chemotherapy with an average of 10,and fluctuated in“U”shape which was similar to that of leukocyte.Conclusions The myelosuppression of TPF induction chemotherapy is manifested as leukopenia accompanied by neutropenia with a“U”shaped fluctuation pattern.Early detection and treatment of myelosuppression according to the fluctuation rule can avoid infection and serious side effects,therefore facilitate successful performance of TPF induction chemotherapy and radical radiotherapy in NPC patients.

关 键 词：鼻咽癌 TPF方案 骨髓抑制 

分 类 号：R739.63[医药卫生—肿瘤]