雷替曲塞联合奈达铂同步螺旋断层放疗治疗局部晚期鼻咽癌的临床研究

Clinical study of raltitrexed plus nedaplatin combined with concurrent helical tomotherapy for locally advanced nasopharyngeal carcinoma

目的比较雷替曲塞联合奈达铂与多西他塞联合奈达铂同步螺旋断层放疗(HT)治疗局部晚期鼻咽癌的疗效和安全性。方法回顾性分析2011年3月至2015年4月84例初治局部晚期鼻咽癌患者的临床资料,其中31例接受雷替曲塞联合奈达铂方案同步HT治疗(RN+HT组),53例接受多西他赛联合奈达铂方案同步HT治疗(DN+HT组)。HT处方剂量:PGTVnx及PGTVnd 70~72Gy/33次,PTV1 60Gy/33次,PTV2 50Gy/28次,5次/周。RN+HT组:雷替曲塞2.5 mg/m^2静滴,d_1;奈达铂共75 mg/m^2静滴,d_1~d_5。DN+HT组:多西他赛35~40 mg/m^2静滴,d_1、d_8;奈达铂共75 mg/m^2静滴,d_1~d_5。两组化疗方案均以21天为1周期,化疗2个周期。比较两组的远期生存情况和不良反应。结果全组中位随访21.5个月。RN+HT组局部复发1例,远处转移2例,死亡2例;DN+HT组局部复发2例,远处转移3例,死亡3例。RN+HT组和DN+HT组的2年生存率分别为93.5%和94.3%,2年无进展生存率分别为90.3%和90.6%,差异均无统计学意义(P>0.05)。两组急性不良反应包括口腔黏膜炎、皮肤损伤、腮腺损伤、咽喉炎、白细胞减少、体重减轻及恶心呕吐等,多为1~2级。DN+HT组恶心呕吐的发生率高于RN+HT组,差异有统计学意义(P<0.05);其他不良反应发生率的差异均无统计学意义(P>0.05)。两组晚期损伤主要为皮肤损伤、皮下纤维化和口干症,不良反应发生率的差异无统计学意义(P>0.05)。结论 RN方案同步HT是局部晚期鼻咽癌的有效治疗方案,且不良反应可耐受。

Objective To investigate the efficacy and toxicities for patients with locally advanced nasopharyngeal carcinoma （NPC） treated by helical tomotherapy （HT） in combination with ra]titrexed plus nedaplatin chemotherapy （RN＋HT） or with docetaxel plus nedaplatin chemotherapy（DN＋HT）. Methods A total of 84 diagnosed local/regional advanced NPC patients from Mar 2011 to Apr 2015 were enrolled in this study, among whom 31 cases received RN＋HT treatment （rahitrexed 2. 5 mg/m^2 iv, d1 ;nedaplatin in to- tal 75 mg/m^2 iv,d1-d5） , and 53 cases received DN＋HT treatment （docetaxel 35-40 mg/m^2 iv, d1 ,d8; nedaplatin in total 75 mg/m^2 iv, d1 -d5 ）. All the patients were treated with chemotherapy for 2 cycles with 21 days as a cycle. Long-term efficacy and toxicities were compared between the two groups. Results The median follow-up period was 21.5 months of 84 patients. There were 1 case of local recurrence, 2 cases of distant metastasis, and 2 cases of death in RN＋HT group. And in DN＋HT group, there were 2 case of local re- currence, 3 cases of distant metastasis and 3 cases of death. The 2-year survival rate of RN＋HT and DN＋HT groups was 93.5% and 94. 3%（P〉0.05）, and the 2-year progression-free survival rate was 90. 3% and 90. 6%（P〉0. 05）. The most common acute adverse reactions were 1-2 grade mucosa reaction, skin injury, hematologic toxicities, weight loss, parotid injury, sphagitis and nausea/vomit- ting. Nausea/vomitting was higher in DN＋HT group than in RN＋HT group （P〈0.05） , and no differences were found in other adverse actions between the two groups（ P〉0. 05）. Chronic injuries included skin injury, subcutaneous fibrosis and xerostomia, and no differ- ences were found between the two groups （P〉0. 05）. Conclusion RN＋HT is effective and well-tollerated for locally advanced NPC.