紫杉醇、顺铂及卡培他滨联合放疗治疗晚期鼻咽癌的疗效观察

Combination of chemotherapy with paclitaxel,cisplatin and capecitabine plus radiotherapy in treatment of advanced nasopharyngeal carcinoma

目的探讨紫杉醇、顺铂及卡培他滨方案(TPX)联合放疗治疗晚期鼻咽癌的疗效及安全性。方法 2002年2月至2007年9月收治57例Ⅲ、ⅣA期鼻咽癌患者,先予直线加速器常规放疗,鼻咽原发灶2Gy/f,每周5次,DT 70Gy,7周完成。放疗后2周,29例给予TPX方案化疗(紫杉醇175mg/m2静滴,d1;顺铂25mg/m2静滴,d1～d3;卡培他滨1.5g/m2口服,d1～d14,3周为1周期);另28例给予TP方案化疗(紫杉醇175mg/m2静滴,d1;顺铂25mg/m2静滴,d1～d3,3周为1周期)。两组均化疗4周期。化疗完成后对两组的近期疗效和总生存期进行比较。结果 TPX组和TP组的总有效率(RR)分别为96.5%和92.9%(P>0.05);3年生存率分别为82.8%和57.1%(P<0.05);3年远处转移率分别为24.1%和50.0%(P<0.05);PTX组骨髓抑制、胃肠道反应、神经毒性及肝肾功损害等毒副反应与TP组相近(P>0.05),手足综合征高于TP组(P<0.05)。结论 TPX方案较TP方案联合放疗能提高晚期鼻咽癌的生存率,减少远处转移,且化疗毒副反应可以耐受。

Objective To evaluate the efficacy and safety of protocol chemotherapy TPX regimen（ paclitaxel, cisplatin and capecitabine） plus radiotherapy for the patients with advanced nasopharyngeal carcinoma （NPC）. Methods From February 2002 to September 2007, 57 patients with stage m, IVA NPC（92 stage system） were enrolled in this study. All patients were given radiotherapy at first, 2Gy per fraction, 5 fractions a week last for 7 weeks. DT was 70Gy. Two weeks after radiotherapy, 57 patients were divided into two groups. The TPX group （paclitaxel 175mg/m2 d1 ,cisplatin 25mg/m2 dx-d3, capecitabine 1.5g/m2 dx-dl4, 3 weeks was a cycle） had 29 patients and the TP group （paclitaxel 175mg/m2 dI , eisplatin 25mg/m2 dI -d3, 3 weeks was a cycle） had 28 patients. There were four cycles for two chemotherapy regimen. Results The overall response rates of TPX group and TP group were 96. 5% , 92. 9% （ P 〉 0. 05 ）. The 3-year survival rates of PTX group and PT group were 82. 8% and 57.1% （ P 〈 0. 05 ）. The 3-year distant metastasis rate was 24. 1% in PTX group and 50. 0% in TP group （P 〈0. 05）. Bone marrow depression, gastrointestinal side reaction, neurotoxicity, hepatotoxicity, nephrotoxicity and oral mucositis of TPX group were similar to those of TP group（ P 〉 0. 05 ）. The occurrence of hand-foot syndrome was significantly increased in TPX group. Conclusion Compared with TP regimen, TPX regimen combined with radiotherapy in advanced NPC can improve survival rate and decrease distant metastasis rate, and it is well tolerated.