紫杉醇脂质体联合奈达铂诱导化疗加奈达铂同期放化疗治疗局部晚期鼻咽癌的近期疗效临床研究

Clinical research of short-term efficacy of paclitaxel liposome combined with nedaplatin induction chemotherapy associated concomitant radio-chemotherapy for locally advanced nasopharyngeal carcinoma

目的比较紫杉醇脂质体联合奈达铂（TN）方案诱导化疗加奈达铂同期放化疗与传统氟尿嘧啶联合顺铂（PF）方案化疗治疗局部晚期鼻咽癌的近期疗效及耐受性。方法56例初诊局部晚期（UICC分期Ⅲ、Ⅳ期）鼻咽癌患者入组，随机分为TN方案诱导化疗加奈达铂同期放化疗组（A组，28例），PF方案诱导化疗加顺铂同期放化疗方案组（B组，28例）。诱导化疗每3周重复，共2个周期，第7周开始同步放化疗。结果A组诱导化疗后鼻咽肿瘤消退有效率为78．6％，B组为75．0％（P〉0．05）；A组颈部淋巴结消退有效率为82．1％，B组为75．0％（P〉0．05）；A组同步放化疗后鼻咽肿瘤消退有效率为96．4％，B组为85．7％（P〉0．05）；A组颈部淋巴结消退有效率为96．4％，B组为85．7％（P〉0．05）。毒副反应方面，Ⅱ度以上的口腔黏膜炎发生率和胃肠道不良反应发生率A组明显低于B组，两组间比较差异有统计学意义（P〈0．05）。结论紫杉醇脂质体联合奈达铂方案诱导化疗加奈达铂同期放化疗是治疗晚期鼻咽癌的有效可行方案，近期疗效好，不良反应较传统方案明显减少，耐受性好。

Objective To compare the efficacy and safety of paclitaxel liposome combined with nedaplatin induction chemotherapy（TN regimen） associated concurrent radio-chemotherapy with FU com- bined Cisplatin（PF regimen） on patients with locally advanced nasopharyngeal carcinoma. Methods Fifty-six patients with locally advanced nasopharyngeal carcinoma were randomly divided into two groups to receive TN regimen concurrent chemoradiotherapy（group A, n = 28） and PF regimen concurrent chemoradiotherapy （group B, n = 28） respectively. Induction chemotherapy was repeated every 3 weeks, a total of 2 cycles. Concurrent chemoradiotherapy was performed in the 7th week. Results The response of primary tumor and toxicity were observed. After induction chemotherapy the nasopharyngeal tumors＇ effective rates of the group A and B were 78.6% and 75.0% respectively, and cervical lymph nodes subsided effective rates were 82. 1% and 75.0% respectively. There was no statistical significant difference between the two groups （ P 〉 0. 05 ）. After concurrent chemoradiation the nasopharyngeal tumors＇ effective rates of the group A and group B were 96. 4% and 85.7% respectively, and cervical lymph nodes subsided effective rates were 96.43% and 85.71% respectively. There was no statistical significant difference between the two groups （ P 〉 0. 05 ）. The rates of oral mucosa reactions above degree Ⅱ and gastrointestinal reactions in group A were significantly lower than those in group B. There was statistical significant difference between the two groups（P 〈 0. 05）. Conclusions Paclitaxel liposome combined with nedaplatin induction chemotherapy followed concurrent radio-chemotherapy is an effective and tolerable regimen in the treatment of locally advanced nasopharyngeal carcinoma. Adverse reactions reduced compared to the traditional regimen significantly