鼻咽癌远处转移化疗新方案近期疗效及治疗策略初探

Preliminary study of new chemotherapy regimen and therapeutic strategy on distant metastatic nasopharyngeal carcinoma

目的：探索高剂量强度非铂类联合化疗方案对鼻咽癌远处转移的近期疗效，及多疗程巩固交替的治疗方法在鼻咽癌远处转移治疗中的价值。材料及方法：共收治鼻咽癌远处转移患者１７例。全部病例第一、二疗程均使用紫杉醇＋异环磷酰胺（ＰＩ）联合化疗。其后再选择不同的联合化疗方案，每种连用２３个疗程交替化疗至６８疗程。３周为一疗程。结果：两程ＰＩ方案总有效率约８２％，其中ＣＲ１２％；ＰＲ７０％。所有病例均发生骨髓抑制、脱发。其它不良反应轻微。６８程化疗耐受性良好，再获ＰＲ４例，１０例ＳＤ；１例原ＰＤ患者病情继续进展。目前２例死亡，３例病情进展，其它患者均已随访２９个月无进展，截止９８年１０月中位生存期９±２５个月。结论：高剂量强度ＰＩ方案对鼻咽癌远处转移有较好疗效，不良反应可以耐受。多方案交替、多疗程巩固化疗有利于改善预后。

Objective: To evaluate the shortterm therapeutic effects of high intensity noncisplatinum combination chemotherapy regimen and to explore the treatment method of multiregimen alternation and multicourse consolidation in the treatment of distant metastatic nasopharyngeal carcinoma. Methods: There were 17 patients collected and treated.During the first and second course of treatment,all cases were treated with the combination chemotherapy including paclitaxel+ifosfamide(PI). Courses were repeated every three weeks. After two courses,different combination chemotherapy regimen were selected to treated alternatively until 6 to 8 courses. Results: The total effective rate is 82%(CR 12%and PR70%) in the two courses of PI regimen. The adverse reactions included serious myelosuppression and alopecia.Other reactions were different from each cases.All the adverse reactions did not affect the continual treatment.The tolerance of the patients in 68 courses was good.Four patients acquired PR again,ten patients kept SD;The only PD patient continued progressively. Till now, two patients died and 3 cases were progressive, all other patients had been followedup 2 to 9 months and kept stable.The medium survival time was 925 months until October 1998 Conclusion: The high intensity PI combination chemotherapy regimen is effective. Its adverse reactions can be tolerated. The treatment method of multiregimen alternation and multicourse consolidation can improve the prognosis of distant metastatic nasopharyngeal carcinoma.