紫杉醇与甘氨双唑钠在局部晚期鼻咽癌放疗中的增敏作用比较

Radio-sensitization effect of paclitaxel versus sodium glycididazole for local advanced nasopharyngeal carcinoma

目的比较紫杉醇(PTX)与甘氨双唑钠(CMNa)在鼻咽癌放疗中的增敏作用和不良反应。方法首程治疗的82例鼻咽癌患者,随机分为紫杉醇增敏组(PTX组)和甘氨双唑钠增敏组(CMNa组),在全程放疗中PTX组给予PTX 60 mg/m2静脉滴注(先给予地塞米松常规预处理),1次/10 d,共5次。CMNa组于每周1、3、5放疗前静脉滴注CMNa 0.75～1.0 g,连用7周。采用热塑面罩固定、低熔点挡铅的常规放疗方法放疗。结果放疗结束时及放疗后3个月2组患者的鼻咽部病灶及颈部转移病灶完全消退率均无明显差异。随诊5～50个月(中位20个月),PTX组的远处转移率(28.6%)低于CMNa组(50.0%),差异有统计学意义(P<0.05)。PTX组鼻咽及颈部复发率低于CMNa组,但差异无统计学意义(P>0.05)。PTX组2、3级口腔黏膜炎、白细胞减少较CMNa组明显,差异有统计学意义(P<0.01)。结论在放疗中加入低剂量PTX对局部晚期鼻咽癌的增敏作用与CMNa相当。前者能减少远处转移的发生,但增加了急性不良反应,特别是口腔黏膜炎和白细胞减少。

Objective To evaluate the radio-sensitization effect and side effect of paclitaxel（PTX） versus sodium glycididazole（CMNa） in local advanced nasopharyngeal carcinoma.Methods 82 patients were randomly divided into the PTX group（n=42） and the CMNa group（n=40）.The PTX group was received 60 mg/m2 of PTX via intravenous infusion,every 10 days for 5 times in the radiotherapy duration.The CMNa group received injections of CMNa at a dose of 0.75-1.0g before the radiotherapy 3 times per week for 7 weeks.All patients received conventional fractionation radiotherapy.Results There was no significant difference in complete tumor remission between the two groups at the end of the therapy and 3 months after radiotherapy.The median follow-up times was 20 months.The metastasis rate in the PTX group（28.6%） was significantly lower than in the CMNa group（50.0%）（P0.05）.The regional recurrence rate was lower in the PTX group than in the CMNa group,but there was no significant difference（P0.05）.Oral cavity mucositis in grades 2 and 3 and leukopenia in the PTX group were more frequent than in the CMNa group（P0.01）.Conclusion Small dose paclitaxel was similar to CMNa in radio-sensitization efficiency for local advanced nasopharyngeal carcinoma,and paclitaxel plus radiotherapy could reduce metastasis,but increase some acute toxicities,especially in oral cavity mucositis and leukopenia.