同步放化疗对Ⅲ、Ⅳa期鼻咽癌的近期效果及毒副作用观察

Clinical and side effect of the short term radiotherapy combining with chemotherapy on nasopharyngeal carcinoma patients with stages Ⅲ and ⅣA

目的 观察Ⅲ期、Ⅳa期鼻咽癌放疗同步两种化疗方法的近期效果及其毒副作用.方法 将150例确诊为Ⅲ期、Ⅳa期鼻咽癌患者随机分为同步放化疗A组75例和同步放化疗B组75例,两组均给予根治性调强放疗,A组在放疗的同时予2个周期（21 ～ 28 d/周期）化疗,紫杉醇135 mg/m^2＋顺铂80 mg/m^2方案;B组放疗同时给予每周1次顺铂30 mg/m^2同步化疗,共化疗6周期.观察两种化疗方法的近期效果及其毒副作用.结果 （1）放疗结束后A组与B组原发病灶完全缓解（CR）率分别为68.0％（51/75）与52.0％ （39/75）,颈部淋巴结CR率分别为64.0％（48/75）与48.0％（36/75）,原发病灶并且颈部病变淋巴结CR率分别为45.3％（34/75）与20.0％（15/75）,差异均有统计学意义（x2值分别为4.25、3.90、10.94,P均＜0.05）;放疗后3个月复查A组与B组原发病灶CR率、颈部淋巴结CR率、原发病灶并且颈部病变淋巴结CR率差异均无统计学意义（P均＞0.05）.（2）治疗期间毒副作用：A组与B组Ⅲ度骨髓抑制发生率分别为38.67％（29/75）与21.33％（16/75）,Ⅲ度消化道反应发生率分别为21.33％（16/75）与6.67％ （5/75）,Ⅲ度口腔黏膜损伤发生率分别为46.66％（35/75）与21.33％（16/75）,Ⅲ度放射性皮肤损伤发生率分别为21.33％ （16/75）与9.34％ （7/75）,差异均有统计学意义（P均＜0.05）.（3）短期随访结果：随访1～3年,两组局部复发率及远处转移率差异无统计学意义（P＞0.05）.结论 放疗同步紫杉醇135 mg/m^2＋顺铂80 mg/m^2化疗组与放疗同步顺铂30 mg/m^2同步化疗组比较,治疗期间紫衫醇＋顺铂组毒副作用较单纯顺铂组大,但近期疗效观察未见明显差异,远期疗效有待进一步评估.

Objective To explore the short term treatment effectiveness and the side-effect of radiotherapy combined with two kinds of chemotherapy scheme on nasopharyngeal carcinoma patients with stage Ⅲ and Ⅳa.Methods One hundred and fifty nasopharyngeal carcinoma cases with stage Ⅲ/Ⅳa were randomly divided into A and B group.Patients in A group （75 cases） were received radiotherapy combined with 2 courses （（21-28） d/course） paclitaxel （135 mg/m^2） ＋ cis-platinum complexes （DDP） 80 mg/m^2 chemotherapy concurrently,while patients in B group （75 cases） were received radiotherapy combined with 6 courses DDP 30 mg/m^2 per week chemotherapy concurently.The short term treatment effectiveness and the sideeffect of radiotherapy combined with two kinds of chemotherapy scheme were observed.Result After the treatment,the primary lesion complete remission（CR） rate in A group and B group were 68% （51/75）,52% （39/75）.The CR rate of lymph node of neck in A and B group was 64.0% （48/75）,48.0% （36/75） and 45.3% （34/75）,20.0% （15/75） of primary lesion and lymph node of neck.The differences were significant（x^2=4.25,3.90,10.94 ;P 〈0.05）.After 3 months of treatment,there was no significant difference between A and B group in terms of CR rate of the primary lesion,lymph node of neck and primary lesion and lymph node of neck （P 〉0.05）.During the treatment,the rate of bone marrow depression at grade Ⅲ in A group and B group were 38.67% （29/75） and 21.33% （16/75）,21.33% （16/75） and 6.67% （5/75） in terms of the rate of grade gastrointestinal reaction at stage Ⅲ,46.66% （35/75） and 21.33% （16/75） regarding of oral cavity mucomembranous injury at stage Ⅲ,21.33% （16/75） and 9.34% （7/75） in terms of the rate of radioactivity skin destruction at stage Ⅲ.All differences were significant （P 〈 0.05）.During the short-term follow up （1-3 years）,both the rate of local recurrence and the rate of metastasis in A group was as same as that in B group（P 〉0.05）.Conclusion During the treatment,the side-effect of approach of paclitaxel （135 mg/m^2） ＋ DDP 80 mg/m^2 in stage Ⅲ/Ⅳa nasopharyngeal carcinoma patients is more severity than that of DDP 30 mg/m^2 per week chemotherapy.However,there is no significant difference in terms of the short term treatment effectiveness.The prospective efficacy needs to be further investigation.