TPF方案诱导时间调节化疗对局部晚期鼻咽癌的近期疗效、毒副反应和患者免疫功能的影响

The short-term curative effects,toxicity and side effects of TPF regimeninduced time conditioning chemotherapy and its effects on immune function of patients with local advanced nasopharyngeal carcinoma

目的分析TPF方案诱导时间调节化疗治疗局部晚期鼻咽癌的近期疗效、毒副反应和对患者免疫功能的影响。方法收集就诊晚期鼻咽癌患者82例,患者首先进行TPF方案诱导化疗,再进行调强放射治疗。按照患者及家属的意愿随机分为2组,其中,在TPF方案诱导化疗过程中A组的43例患者实行诱导时间调节化疗,B组的39例患者实行诱导常规化疗。比较2组患者的近期疗效、毒副反应和患者的免疫功能情况。结果 2组患者在化疗后分别有43例、39例患者可以进行疗效评估,A组患者的有效率为83.72%显著高于B组的51.28%(χ2=9.9384,P=0.0016);A、B 2组患者在放疗后分别有41例、37例患者可以进行疗效评估,A组患者的有效率为100%显著高于B组的89.19%(χ2=4.6720,P=0.0307);2组患者的白细胞(WBC)减少、中性粒细胞(GRA)减少的血液学毒副反应发生比例间比较,差异有统计学意义(P<0.05);而血红蛋白(HGB)减少、血小板(PLT)减少、丙基酸氨基转移酶(ALT)增多、天门冬氨酸氨基转移酶(AST)增多以及肌酐增多的血液学毒副反应发生比例比较,差异无统计学意义(P>0.05);2组患者的恶心、呕吐、便秘、腹泻以及口腔黏膜炎的非血液学毒副反应发生比例间比较,差异有统计学意义(P<0.05);其他非血液学毒副反应(厌食、乏力、皮疹和感染)发生比例比较,差异无统计学意义(P>0.05);化疗前2组患者的外周血淋巴细胞(CD+3、CD+4、CD+8、CD+4/CD+8、CD+19和CD+16+CD+56)百分比间比较,差异无统计学意义(P>0.05);化疗后,2组患者CD+4/CD+8的百分比比较,差异有统计学意义(P<0.05);而化疗后其他淋巴细胞间比较,差异无统计学意义(P>0.05)。结论对于局部晚期鼻咽癌患者,采用TPF方案诱导时间调节化疗方式的近期疗效较好、毒副反应较低、免疫功能受影响较小,值得临床上应用推广。

Objective To observe the short-term curative effects , toxicity and side effects of TPF regimen induced time conditioning chemotherapy and its effects on immune function of patients with local advanced nasopharyngeal carcinoma . Methods Eighty-two patients with advanced nasopharyngeal carcinoma who were admitted and treated in our hospital from October 2014 to December 2015 were enrolled in the study .These patients were treated firstly by TPF regimen induced time conditioning chemotherapy ,then who were treated by intensity modulated radiotherapy .According to the wishes of patients and their families , the patients were randomly divided into two groups , 43 patients in group A were treated by TPF regimen induced time conditioning chemotherapy , however , the other 39 patients in group B were treated by induction conventional chemotherapy .After treatment the short-term curative effects , toxicity andside effects and changes of immune function of patients were observed and compared between two groups .Rseults After chemotherapy , the effective rate in group A was significantly higher than that in group B （ 83.72%vs 51.28%,χ2=9.938,P 〈0.01）.After radiotherapy,the effective rate in group A was significantly higher than that in group B （100%vs 89.19%,χ2 =4.672, P 〈0.05）.There were significant differences in the hematologic toxicity and side effects including the decrease of white blood cell （ WBC ） and neutrophilic granulocyte between two groups （ P 〈0.05）,however,there were no significant differences in the decrease of hemoglobin （HGB） and platelet （PLT）,the increase of propyl acid aminotransferase （ALT）,aspartate aminotransferase （AST） and creatinine between two groups （ P 〉0.05）.There were significant differences in the side effects including nausea ,vomiting, constipation, diarrhea, oral cavity mucocitis between two groups （ P〈0.05）,however, there were no significant differences in the other side effects including anorexia , fatigue,rashes and infections between two groups （ P 〉0.05）.Before chemotherapy, there were no significant differences in the percentages of CD 3＋,CD4＋,CD8＋,CD4＋/CD8＋,CD1＋9 , CD1＋6 ＋CD5＋6 in peripheral blood lymphocytes between two groups （ P 〉0.05 ）, however, after chemotherapy ,there was a significant difference in the ratio＆nbsp;of CD＋4/CD 8＋between two groups （ P 〈0.05）,moreover, there were no significant differences in percentages of the other lymphocytes between two groups （ P 〉0.05）.Conclusion The short-term curative effects of TPF regimeninduced time con-ditioning chemotherapy on local advanced nasopharyngeal carcinoma are satisfactory,with fewer toxicity and side effects and less effects on immune function of patients ,thus, which is worth using widely in clinical practice .