小剂量健择联合顺铂方案在鼻咽癌放疗中的增敏价值

The Radiosensitizing Effect of Low Dose Gemcitabine Combined with Cisplatin in the Treatment for Nasopharyngeal Carcinoma

[目的]研究每周小剂量健择+顺铂方案(GP)化疗在局部晚期鼻咽癌放射增敏的临床疗效及可行性。[方法]2003年3月至2006年10月,32例初治鼻咽癌患者放疗过程中接受4～7个疗程GP方案增敏化疗。化疗剂量:顺铂12.5mg/(m2·w)、健择125mg/(m2·w)。放疗剂量:鼻咽原发病灶(GTVnx)DT70Gy～76Gy/35～38次,7～8周,颈部淋巴结病灶(GTVnd)DT70Gy/35次,7周,亚临床病灶(CTV)DT50Gy/25次,5周;分别观察GTVnx、GTVnd消失时的放疗剂量,采用RTOG评分标准评价治疗过程的急性放射性反应。[结果]放疗结束时GTVnx、GTVnd完全缓解率分别为93.75%(30/32)和91.67%(22/24),GTVnx、GTVnd消失所需的放射剂量分别为(43.93±12.50)Gy和(48.86±13.69)Gy。无Ⅳ级毒副反应发生。[结论]小剂量GP方案明显增强鼻咽癌的放射敏感性,提高放疗增益,不增加急性放射反应,对晚期鼻咽癌值得进一步研究。

[Purpose] To evaluate the feasibility and efficacy of weekly low dose gemcitabine and cisplatin in radiosensitizing for patients with locoregionally advanced nasopharyngeal carcinoma （NPC）. [Methods] From March 2003 to October 2006, 32 initially treated NPC were treated with concurrent low dose gemcitabine and cisplatin chemotherapy and radiotherapy. Gemcitabine 125mg/m^2 weekly and DDP 12.5mg/m^2 weekly were administered for four to seven cycles from the first day of radiotherapy （RT）. The prescription radiation dose was 70 to 76Gy to nasopharynx gross tumor volume （GTVnx）, 70Gy to positive neck lymph nodes （GTVnd）, 50Gy to sub-clinical target volume. The primary endpoints were the dose to achieve complete response （CR） for primary tumor and neck lymph node. Acute normal tissue effects were graded according to Radiation Therapy Oncology Group （RTOG） radiation morbidity scoring criteria. [Results] At the end ofRT, the complete response （CR） rate of GTVnx and GTVnd were 93.75% （30/ 32） and 91.62% （22/24）, respectively. The dose to achieve complete response （CR） for nasopharynx and neck lymph node were （43.93±12.50）Gy and （48.86±13.69）Gy, respectively. No gradeⅣ toxicity occurred. [Conclusion] Low dose gemcitabine combined with low dose cisplatin can increase the radiosensitivity of locally advanced NPC, improving the CR rate with no serious toxicity.