TPF方案诱导化疗口腔癌后Ⅳ度骨髓抑制的临床分析

Grade IV myelosuppression after induction chemotherapy of TPF on oral cancer:clinical analysis of 29 cases

目的：观察和研究常规剂量下多西他赛联合顺铂和氟尿嘧啶（TPF方案）在口腔黏膜鳞状细胞癌的诱导化疗后出现的达到Ⅳ度骨髓抑制的临床特征和治疗策略。方法：2006-2012年间接受TPF方案治疗口腔黏膜鳞癌147例，均为首治病例。对其中出现Ⅳ度骨髓抑制的29例进行回顾分析，就骨髓抑制的规律和治疗策略，白细胞和中性粒细胞的波动规律和粒细胞集落刺激因子（CSF）的疗效进行分析。结果：29例出现骨髓抑制的时间为化疗后9—14d，中位时间10d，平均时间10．5d；波动的规律呈“U”形，低谷持续时间3～5d。26例经CSF治疗后，平稳过渡到正常或下限水平，并如期行联合根治手术．创口未出现延迟愈合；2例因升白细胞治疗不理想而被要求改用“小剂量适形调强放疗”：1例因升白细胞治疗无效而并发多脏器衰竭死亡。化疗死亡率0．68％。结论：Ⅳ度骨髓抑制的发生率虽然不高但有致死性危险．本研究揭示了”U”形波动发生的起始时间和同期采用升白细胞治疗的必要性，启动骨髓抑制的应急预案。即单人消毒病房，以漱121液交替含漱；应用CSF类药物应达到正常水平上限的倍数。

PURPOSE： To observe and evaluate the clinical features and treatment strategies of IV myelosuppression after induction chemotherapy of oral mucosa squamous cell carcinoma under conventional dosage. METHODS： Twenty-nine patients of oral mucosa squamous cell carcinoma pathologically diagnosed between 2006 and 2012 were enrolled into this study. The patients received induction chemotherapy with docetaxel-cisplatin-5-fluorouracil （TPF） and suffered from grade IV myelosuppression. Regulations and treatment strategies of the bone marrow myelosuppression were analyzed, retrospectively. RESULTS： Twenty-nine cases had bone marrow suppression 9-14 days after induction chemotherapy, and the median time was 10 days, with a ＂U＂-shaped fluctuation pattern. There were 26 cases with colony-stimulating factor （CSF） therapy completing treatment according to the schedule and 2 cases were required to radiotherapy because of unsatisfied effect of CSF therapy. One case died and the death rate after chemotherapy was 0.68% in this group. CONCLUSIONS： The incidence of grade IV myelosuppression is normal and fatal. This study shows the starting time of the ＂U＂-shaped fluctuation and the necessaries of adding CSF therapy at the same time. The emergency treatment of myelosuppression should be used including single disinfected ward mouthwash and therapy of CSF drug.