摘要
目的:比较2种化疗方案诱导联合同期放化治疗鼻咽癌的依从率、毒副作用和近期疗效。评价2种化疗方案在该治疗模式的可行性。方法:采用前瞻性非随机对照研究。化疗方案:CbF组36例,卡铂50mg/m2第1~5天,5-氟尿嘧啶750mg/m2第1~5天;PF组38例,顺铂20mg/m2第1~5天,5-氟尿嘧啶750mg/m2第1~5天,均为每3周重复,共3个周期,于放疗前第1周给予第1周期诱导化疗。放疗方案:采用鼻咽癌常规放疗标准方案,应用10MV-X和10MeV-β或12MeV-β外照射,NPTD64~80Gy、颈淋巴结(+)TD64~70Gy、颈淋巴结(-)TD40~50Gy,2Gy/次,5次/周。结果:第2、3周期化疗依从率,CbF组:77.8%和16.7%(P=0.00),PF组:84.2%和42.1%(P=0.00),且组间比较P=0.48和P=0.03;鼻咽、颈淋巴结(+)的实际照射时间和理论照射时间,CbF组:(56±5)d和(52±2)d(P=0.00)、(46±6)d和(42±4)d(P=0.00),PF组:(53±6)d和(50±3)d(P=0.07)、(42±5)d和(42±3)d(P=0.97);3度以上毒副作用:CbF组与PF组口腔、咽黏膜反应分别为63.9%和13.2%(P=0.00),放射性皮炎、骨髓抑制、胃肠反应、肝肾功能毒性比较均为P>0.05。近期疗效:CBF组和PF组的鼻咽肿瘤、颈淋巴结(+)的CR率分别为86.11%和89.47%(P=0.93)、77.78%和90.00%(P=0.37),但TD≤50Gy阶段,颈淋巴结(+)的CR率分别为36.66%和11.11%(P=0.03)。放化疗后CbF组和PF组患者中位随诊17个月局部区域残留、复发及远处转移率比较均相似(P>0.05)。结论:CbF和PF化疗方案在该治疗模式的化疗依从性差,但具有高度肿瘤完全消退率。化、放疗依从性、毒副作用和近期疗效PF组显示出一定优势。
Objective: To compare the short-term effects of two kinds of chemotherapy combined respectively with radiotherapy on nasopharyngeal carcinoma, compliance of patients and toxicity ; to evaluate the feasibility of this two methods in the treatment model. Methods: A prospective non-randomized control study was designed. Patients were divided into group A (36 cases) and group B (38 cases), patients in group A underwent chemotherapy using CbF, 50 mg/m^2 earboplat for 1 - 5 days, 5 - fluorouracil 750 mg/m^2 for 1 - 5 days, and patients in group B underwent chemotherapy using PF, cisplatin 20 mg/m^2 for 1 - 5 days, 5 - fluorouracil 750 mg/m^2 for 1 - 5 days, repeated every 3 weeks for three cycles. First cycle of induction chemotherapy was practiced first week before radiotherapy. Standard conventional radiotherapy for nasopharyngeal carcinoma was used, external exposure with 10MV-X and IOMeV-β or 12MeV-β, NPTD 64 N 80 Gy, neck lymph node ( + ) TD 64 - 70Gy, cervical lymph node (-) TD 40 - 50 Gy, 2 Gy/time, 5 times/week. Results: The chemotherapy compliance rates of group A and group B in the second and third week were 77.8% vs 84.2% and 16.7% vs 42.1% respectively (P = 0.00), and inter-group comparison : P = O. 48 and P = 0.03. The actual and theoretic exposure time of nasopharynx and cervical lymph node ( + )in different group were: group A: (56 ±5 ) d and (52 ± 2) d (P = 0.00), (46± 6) dand (42 ± 4 ) d (P = 0.00) group B: (53± 6) d and (50 ±3) d (P=0. 07), 4 (2 + 5 ) d and (42 ± 3) d (P = 0.97). Degree 3 and above side effects: oral and pharyngeal mucosal reactions in group A and B were 63.9% and 13.2% respectively(P = 0.00) ; the differences of incidences of radiation dermatitis, bone marrow suppression, gastrointestinal reactions, and impairment of liver and kidney functions between the two groups were all insignificant( P 〉0.05) Short-term effects: CR rates of nasopharyngeal cancer and cervical lymph node ( +)in group A and B were 86.11% and 89.47% (P= 0.93), 77.78% and 90.00% (P =0.37) respectively, but for TD ≤ 50 Gy region, CR rate of cervical lymph node ( + ) was 36.66% and 11.11% respectively (P = 0.03). The differences of incidences of local residue and relapse, distant metastasis between the two groups were similar (P 〉 0.05 ) according to median 17 months follow-up after radiotherapy and chemotherapy. Conclusion: For both CbF and PF chemotherapy, compliance of patients was poor and rate of tumor regression was high; patients underwent PF chemotherapy and radiotherapy have advantages over CbF at compliance, side effects and short-term effects.
出处
《海南医学院学报》
CAS
2009年第9期1084-1088,共5页
Journal of Hainan Medical University
基金
海南医学院科研基金资助学报项目(0020090148)~~
关键词
鼻咽癌
药物疗法
放射疗法
Nasopharyngeal carcinoma
Drug therapy
Radiotherapy