含紫杉醇化疗方案治疗晚期头颈部恶性肿瘤

Paclitaxel plus carboplatin or cisplatin for patients with advanccd head and ncck cancer

目的 :探讨紫杉醇类药物分 3周疗法治疗晚期头颈部恶性肿瘤的价值和毒性。方法 :对 5 1例临床Ⅲ—Ⅳ期的头颈部恶性肿瘤患者 (初治 19例 ,复治 32例 )选用紫杉醇与卡铂或顺铂联合治疗 :紫杉醇 75— 10 0mg/m2 ,静滴 ,第 1、8、15天 ,卡铂 30 0— 35 0mg/m2 ,静滴 ,第 2天 ,(或顺铂 2 0mg/m2 ,静滴 ,第 1— 5天 )。每 4周重复 ,共3— 6周期。结果 :5 1例患者完全缓解 (CR) 4例 (7.8% ) ,部分缓解 (PR) 15例 (2 9.4% ) ,无变化 (NC) 18例 (35 .3% ) ,进展 (PD) 14例 (2 7.4% ) ,总有效率 (RR) 37.2 %。疗程中出现耐药复发或转移的 11例 (2 1.6 % )。其中初治的 19例患者中 ,CR 2例 (10 .5 0 ) ,PR 6例 (31.6 % ) ,RR为 42 1% ,较复治患者的RR有显著性差异 (P <0 .0 5 )。主要不良反应 :骨髓抑制、肢体感觉异常、面色潮红、发热、脱发、消化道反应 ,并出现可疑过敏性休克死亡 1例 (2 .0 % )。结论 :含紫杉醇的化疗方案治疗晚期头颈部恶性肿瘤有较好的疗效 ,即使在治疗对常规化疗耐药的患者也能取得一定的疗效 ,多数毒副作用处于可以耐受范围 ,但可能有严重的过敏性反应。

Purpose:To study the efficacy and toxicity of paclitaxel in the treatment of patients with advanced head and neck cancer. Methods:51 patients with stage Ⅲ-Ⅳadvanced head and neck cancer were enrolled, including l9 patients who had no prior chemotherapy, 32 patients who had recurrent head and neck cancer after surgery and/or radiation therapy, and then had become resistant after about two cycles of chemotherapy with fluorouracil plus cisplatin. Three to six cycles of chemotherapy with paclitaxel plus carboplatin or cisplatin were administered: paclitaxel 75-l00mg/m2, qd. d 1?d 8?d 15 plus carboplatin 300-350 mg/m2, qd. d 2 (or cisplatin 20 mg/m2,qd. d 1-5 ), q 4 wk.Results:The total response rate in 51 patents was 19 (37.2%), with 4 (7.8%) complete response, 15 (29.4%) partial respond, l8(35.3%) stable disease and 14 (27.4%) progression. Major toxicities were neutropenia, GI tract reactions and alopecia. One patient had allergic shock and patient died at the beginning of the second cycle of chemotherapy. Conclusions:Paclitaxel is efficient in treating the advanced head and neck cancer. Except for rare cases of allergy, major toxic effects can be tore rated by the patients.