调强放疗同期顺铂时辰化疗联合西妥昔单抗对局部晚期鼻咽癌患者的影响

Impact of concurrent intensity modulated radiation therapy and cetuximab-cisplatin sinusoidal chronomodulated chemotherapy on the locoregionally advanced nasopharyngeal carcinoma patients

目的探讨调强适形放射治疗(IMRT)同期正弦曲线式顺铂时辰化疗联合西妥昔单抗方案治疗局部晚期鼻咽癌的疗效、不良反应和对细胞免疫功能的影响。方法将2009年4月至2012年12月收治的68例局部晚期鼻咽癌患者随机分为实验组(35例)和对照组(33例),实验组采用IMRT同期顺铂正弦曲线式时辰化疗联合西妥昔单抗方案治疗,对照组采用IMRT同期顺铂常规化疗联合西妥昔单抗方案治疗。统计两组的疗效及化疗、放疗引起的急慢性不良反应和T细胞亚群变化。结果两组的完全缓解(CR)、部分缓解(PR)、稳定(SD)、进展(PD)和有效(CR+PR)、疾病控制(CR+PR+SD)的构成比在任何时间段差异均无统计学意义(P均>0.05)。在急性不良反应中,黏膜炎、消化道反应、血红蛋白下降、肝功能异常的发生率实验组低于对照组(P均<0.05)。在放疗引起的慢性不良反应中,实验组黏膜炎的发生率低于对照组(P<0.05)。治疗前两组T细胞亚群水平相近(P均>0.05),治疗后两组T细胞亚群水平有不同程度的下降,而对照组的CD4水平和CD4/CD8比值均低于实验组(P均<0.05)。结论 IMRT同期顺铂正弦曲线式时辰化疗联合西妥昔单抗治疗局部晚期鼻咽癌的疗效明确,可减少急性不良反应和放疗引起的慢性不良反应发生率,减轻对细胞免疫功能的损害,但疗效与IMRT同期顺铂常规化疗联合西妥昔单抗无差别。

Objective To investigate the therapeutic effect, adverse effect and the influence to cellular immune function of concurrent intensity modulated radiation therapy （IMRT） and cisplatin sinusoidal chronomodulated-ehemotherapy cetux- imab for the treatment of locoregionally advanced nasopharyngeal carcinoma patients. Methods Sixty - eight patients with locoregionally advanced nasopharyngeal carcinoma treated between April 2009 and December 2012 were enrolled in this study. The patients were randomly divided into experimental group （ n = 35 ） and control group （ n = 30 ）. The concurrent IMRT and sinusoidal chronomodulated cisplatin-chemotherapy cetuximab protocol was used in experimental group,and the concurrent IMRT and routine eisplatin-chemotherapy cetuximab protocol was used in control group. The curative effect, as well as the acute and chronic adverse reactions and the changes of T-Cell subsets caused by the chemotherapy and radio- therapy in two groups were analyzed. Results There were no statistical differences in the constituent ratios of complete re- mission （CR） , partial remission （ PR）, stabilization （SD） , progressive disease （PD） , response rate （ CR ＋ PR） and dis- ease control rate （ CR ＋ PR ＋ SD） in any time quantum between two groups （ all P 〉 0.05 ）. In the acute adverse reactions, the incidences of mucositis, digestive tract reactions, hemoglobin - lowering and abnormality of liver function were all signif- icantly lower in experimental group than those in control group （ all P 〈 0.05 ）. In chronic adverse reactions caused by the radiotherapy,the incidence of mucositis was significantly lower in experimental group than that in control group （P 〈 0. 05 ）. In two groups, the T - Cell subsets levels were similar before treatment （ all P 〉 0.05 ） and decreased in different de-grees after treatment in which the level of CD4 and the ratio of CD4/CD8 were significantly lower in control group than those in experimental group （ all P 〈 0.05 ）. Conclusions IMRT and sinusoidal chronomodulated cisplatin-chemotherapy cetuximab protocol for the treatment of locoregionally advanced nasopharyngeal carcinoma has clear therapeutic effect and can reduce the incidences of acute adverse reactions and chronic adverse reactions caused by radiotherapy, alleviate the damage of cellular immune function,but its therapeutic effect is indifference compared with the concurrent IMRT and rou- tine cisplatin-chemotherapy eetuximab protocol.