调强放疗联合脂质体紫杉醇和顺铂同期化疗辅助化疗对局部晚期鼻咽癌的疗效研究

Clinical Study of IMRT Combined with Paclitaxel Liposome and Cisplatin in the Treatment of Locally Advanced Nasopharyngeal Carcinoma

目的探讨调强放疗联合脂质体紫杉醇和顺铂同期化疗对局部晚期鼻咽癌的疗效和不良反应。方法 41例局部晚期鼻咽癌患者接受DT70 Gy调强放疗,放疗中给予脂质体紫杉醇175 mg/m2,静脉滴注,第1天;顺铂25 mg/m2,静脉滴注,第1～3天,28天为1个周期,共2个周期。放化疗同天进行,先化疗后放疗。2周后给予3个周期的辅助化疗。结果随访中位时间为34个月(13～41个月)。35例患者完成治疗计划,全组患者3年总生存率和无病生存率分别为92%和78%,Ⅲ、Ⅳ期患者3年总生存率和无病生存率比较,差异无统计学意义(96%:88%,P=0.34;92%:70%,P=0.24)。同期放化疗期间3级以上急性不良反应分别为:白细胞减少4例(10%),恶心呕吐3例(7%),口腔黏膜炎14例(34%),皮肤炎4例(10%)。结论调强放疗联合脂质体紫杉醇和顺铂同期化疗辅助化疗,对局部晚期鼻咽癌患者具有较好的疗效,不良反应可耐受。

Objective To observe the therapeutic effect and toxicities of intensity modulated radiotherapy（IMRT） combined with paclitaxel liposome and Cisplatin in the treatment of patients with locally advanced nasopharyngeal carcinoma（NPC）.Methods 41 patients with locally advanced nasopharyngeal carcinoma received concurrent chemoradiotherapy.The total radiation dose was 70 Gy by IMRT,and 2 cycles of concurrent chemotherapy consisted of paclitaxel liposome 175 mg/m2 on Day 1 and Cisplatin 25 mg/m2 on Day 1 ~3 by intravenous infusion once every 4 weeks.3 cycles of adjuvant chemotherapy were given 2 weeks after radiotherapy.Results 35 patients finished the whole therapeutic schedule.The 3-year overall survival rate and the 3-year disease free survival rate were 92% and 78% respectively.The 3-year overall survival rate was 96% for stage Ⅲ and 88% for stage ⅣA（P=0.34）.The 3-year disease free survival rate was 92% for stage Ⅲ and 70% for stage ⅣA（P=0.24）.The main grade ≥3 acute toxicities during concurrent chemoradiotherapy were neutropenia in 4 cases（10%）,nausea and vomiting in 3 cases（7%）,mucositis in 14 patients（34%）,and dermatitis in 4 cases（10%）.Conclusion IMRT combined with paclitaxel liposome and cisplatin is effective in the treatment of patients with locally advanced NPC,with tolerable toxicities.