局部晚期鼻咽癌放疗联合顺铂或尼妥珠单抗的疗效比较

Comparison of efficacy and adverse reactions between radiotherapy combined with cisplatin and radiotherapy combined with nimotuzumab in treatment of locally advanced nasopharyngeal carcinoma

目的 比较局部晚期鼻咽癌患者TPF方案诱导化疗后放疗联合顺铂或尼妥珠单抗靶向治疗的疗效和不良反应.方法 对2012—2013年间随机分组收治的60例Ⅲ—Ⅳb期鼻咽癌患者进行分析,其中对照组32例、研究组28例.两组患者均先行3周期TPF方案诱导化疗,对照组放疗同步顺铂40 mg/m2,1次/周共7周,研究组放疗前1周开始使用尼妥珠单抗200 mg,1次/周共7周.生存分析采用Kaplan-Meier法并Logrank检验,近期疗效和不良反应采用χ2检验.结果 对照组CR率97%、PR率3%,研究组CR率96%、PR率4%（P=0.923）.3年PFS对照组为88%,研究组为79%（P=0.352）,3年OS对照组为97%,研究组为89（P=0.268）.但疗中骨髓抑制、重度乏力、恶心呕吐反应研究组较轻（P=0.002、0.008、0.001）.结论 放疗联合顺铂与放疗联合尼妥珠单抗靶向治疗局部晚期鼻咽癌患者的疗效无明显差别,但放疗联合靶向治疗的不良反应明显减轻.

Objective To evaluate the efficacy and adverse reactions of radiotherapy combined with cisplatin or nimotuzumab after induction chemotherapy with docetaxel,cisplatin,and 5-fluorouracil （ TPF） for locally advanced nasopharyngeal carcinoma. Methods Sixty patients with stage Ⅲ-Ⅳb nasopharyngeal carcinoma were randomly divided into experimental group （ n=28 ） and control group （ n=32 ） . The two groups received radiotherapy after three cycles of induction chemotherapy with TPF. The control group received cisplatin during radiotherapy at a dose of 40 mg/m2 , once a week, for 7 weeks, while the experimental group received nimotuzumab one week before radiotherapy at a dose of 200 mg,once a week,for 7 weeks. Survival analysis was used with the Kaplan-Meier method and log-rank test, efficacy and adverse reactions comparing were used with χ2 test. Results The short-term treatment outcomes were evaluated at three months after treatment. There were no significant differences in the complete or partial response rates between the control group and the experimental group （ 97% vs. 96% or 3% vs. 4%,P=0. 923） . There were no significant differences in 3-year progression-free survival or overall survival rate between the control group and the experimental group （88% vs. 79%,P=0. 352;97% vs. 89%,P=0. 268） The experimental group had significantly lower incidence rates of marrow suppression,severe fatigue,nausea,and vomiting than the control group （ P= 0. 002, 0. 008, 0. 001 ） . Conclusions There is no significant difference in clinical efficacy between radiotherapy combined with cisplatin and radiotherapy combined with nimotuzumab in the treatment of locally advanced nasopharyngeal carcinoma. However, radiotherapy combined with targeted therapy achieves significantly fewer adverse reactions.