洛铂联合紫杉醇同步放化疗治疗中晚期鼻咽癌的临床观察

Clinical observation of lobaplatin combined with paclitaxel concurrent chemoradiotherapy for advanced nasopharyngeal carcinoma

目的探讨洛铂＋紫杉醇方案化疗联合同步根治性放疗治疗中晚期鼻咽癌的疗效和不良反应。方法选取2010年1月至2012年1月吉林大学第二医院收治的75例鼻咽癌患者，所有患者均给予紫杉醇（135mg/m^2）＋洛铂（30mg／m^2）d1静脉注射，间隔21d后行下个周期化疗，共4个周期。从第1个周期开始同步给予三维适形调强放疗进行治疗，治疗均采取同步加量治疗，5次／周，共7周。原发灶肿瘤临床靶区、颈部淋巴结转移灶临床靶区和高危亚临床靶区分别给予71-72Gy／33次、66Gy／33次和60-62Gy／33次。结果所有患者均完成治疗，包括66例完全缓解，9例部分缓解，总有效率为100％（75／75）。2、3、4年总生存率分别为92．0％、84．0％和81．3％。其不良反应主要为：口腔黏膜炎75例，脱发62例，白细胞减少32例，血小板计数降低22例，恶心呕吐22例，贫血12例，均无重大的肝、肾功能损害。结论洛铂＋紫杉醇方案化疗联合同步根治性放疗治疗中晚期鼻咽癌安全有效。然而，仍需进一步收集病例资料和长期临床观察，以及多中心研究，以确定放疗和化疗药物的最佳剂量和最佳联合化疗方案。

Objective To investigate the efficacy and adverse reaction of lobaplatin plus paclitaxel chemotherapy combined with concurrent radical radiotherapy in the treatment of middle-advanced nasopharyngeal carcinoma. Methods From January 2010 to January 2012,75 cases of nasopharyngeal carcinoma patients from The Second Hospital of Jilin University were selected and given intravenous infusion of paclitaxel （135 mg/m^2） and lobaplatin （30 mg/m^2）dl, in an interval of 21 days for totally 4 cycles. Three dimensional conformal intensity modulated radiation therapy was carried out from the first period of the treatment, and the treatment were treated with simultaneous dosage, 5 times/week, 7 weeks. The primary tumor clinical target volume, cervical lymph node metastases clinical target volume and high-risk subclinical target volume were given 71-72 Gy/33 times, 66 Gy/33 times and 60-62 Gy/33 times. Results All patients completed the treatment, including 66 cases of complete remission, 9 cases of partial remission, and the total effective rate was 100%（75/75）. 2,3,4 years survival rates were 92.0%, 84.0% and 81.3%. The main adverse reactions were 75 cases with oral mucositis,62 cases with alopecia,32 cases with 1eucopenia,22 cases with thrombocytopenia,22 cases with nausea and vomiting and 12 cases with anemia. Conclusions Lobaplatin plus paclitaxel chemotherapy combined with synchronous radical radiotherapy for middle-advanced nasopharyngeal carcinoma is safe and effective. However, further collection of case data and long-term clinical observation, as well as multi-center studies are required to determine the optimal dose of radiotherapy and chemotherapy drugs and the best combination chemotherapy.