局部区域晚期鼻咽癌同期放化疗联合辅助化疗不良反应的临床分析

A Clinical Study of Acute Toxicities of Concurrent Chemoradiotherapy plus Adjuvant Chomotherapy in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

目的探讨局部区域晚期鼻咽癌同期放化疗联合或不联合辅助化疗的治疗毒性及治疗顺应性。方法选取中山大学附属第五医院放疗科2007年6月至2009年12月44例鼻咽非角化型癌(WHO病理分型),第六版AJCC分期Ⅲ-IVb期(T3-4N1或N2-3M0)的患者入组。将患者随机分为同期放化疗组(对照组)和同期放化疗联合辅助化疗组(试验组)。两组均采用根治性常规分割放疗,放疗期间均同时给予顺铂40mg/m2,d1,1次/周,连续7次。试验组患者放疗结束后1个月开始辅助化疗,采用顺铂80mg/m2,d1,5-氟尿嘧啶800mg/m2d1-5,每四周一个疗程,共三个疗程。结果采用意向性分析,比较两组治疗毒性及顺应性。结果两组病例的性别、年龄、一般状况评分、分期方法及临床分期等均具有可比性。两组36.4%(16/44)患者完成7次同期化疗,81.8%(36/44)患者完成6次同期化疗,90.9%(40/44)患者完成5次同期化疗。试验组72.7%(16/22)患者完成3个疗程辅助化疗。全组放疗期间3级以上急性毒性反应为79.5%(35/44)。辅助化疗期间试验组89.4%(17/19)患者发生3级以上毒性反应。结论局部区域晚期鼻咽癌患者使用同期放化疗联合辅助化疗是NCCN推荐的标准治疗。本研究试验组比对照组治疗毒性大,顺应性差,建议对局部区域晚期鼻咽癌患者进行分层治疗,根据年龄、临床分期、一般状况评分进行分层,改善治疗顺应性。

Objective A clinical study of acute toxicities of concurrent chemoradiotherapy plus adjuvant chomotherapy or not in patients with locoregionally advanced nasopharyngeal carcinoma.Methods Between June 2007 and December 2009, 44 eligible patients that had non-keratinizing （WHO classification） NPC and were classified as stage Ⅲ-IVB by the AJCC 6th Edition were enrolled in the study.The patients were treated with concurrent chemoradiotherapy （CRT） or concurrent chemoradiotherapy plus adjuvant chemotherapy（CRT and AC）.All patients were treated by definitive-intent radiation therapy and received concurrent Cisplatin（40 mg/m^2 on day 1） weekly during RT, the experiment group followed by Cisplatin （80 mg/m^2 on day 1） and Florouracil （800 mg/m^2 on day 1 to 5） every 4 weeks for 3 cycles after completion of RT.All patients were assessed by intent-to-treat analysis.The toxicit of regimen and the patient reponse to it were evaluted.Results The two groups were well balanced in the distribution of all prognostic factors and RT parameters, such as sex, age, performance status, staging method and clinical stage. There were 36.4%（16/44） patients who completed all 7 cycles of concurrent chemoradiotherapy, 81.8%（36/44） of which had 6 cycles or more while 90.9%（40/44） completed 5 cycles.72.7%（16/22）patients completed all 3 cycles of adjuvant chemotherapy. The CRT and AC group experienced singnifically more acute toxicities . 79.5%（35/44） patients experienced acute toxicities during CRT, 89.4%（17/19）patients of CRT and AC group experienced acute toxicities.Conclusion As NCCN recommended ,concurrent chemoradiotherapy plus adjuvant chemotherapy is the standard treatment to patients with locoregionally advanced nasopharyngeal cacinoma. In this study , the CRT and AC group experienced singnifically more acute toxicities ,and the adaptability was poor.We recommend to stratify patients with locoregionally advanced nasopharyngeal cacinoma, base on age , clinical stage and performance status, in order to improve adaptability.