TPS1/TPF新辅助化疗治疗局部晚期鼻咽癌的近期疗效分析

A Study of TPS1 and TPF Neoadjuvant Chemotherapy on Curative Effect for Treatment of Patients with Locally Advanced Nasopharyngeal Carcinoma

目的对比TPS1/TPF两种不同新辅助化疗方案治疗局部晚期鼻咽癌的近期疗效和安全性。方法选择2015年12月~2016年8月我院收治的72例局部晚期鼻咽癌患者,随机分为两组。TPS1组行新辅助化疗2周期(多西他赛60mg·m^(-2)、d1,顺铂60 mg·m^(-2)、d1,替吉奥(S-1)60 mg·m^(-2)、d1~14,每天分2次口服)。TPF组行新辅助化疗2周期(多西他赛60 mg·m^(-2)、d1,顺铂60mg·m^(-2)、d1,5-FU 600 mg·m^(-2)、d1~5)。两组患者在2周期新辅助化疗后开始同步放化疗,放疗处方剂量为:PGTVnx:70.4 Gy/32 f,PGTVnd:70.4 Gy/32 f,PCTV1:64 Gy/32 f,PCTV2:57.6 Gy/32 f,PCTV3:50.4 Gy/28 f。同步化疗方案为DDP单药80 mg·m^(-2),2周期。比较两组患者的临床疗效及毒副反应发生情况。结果新辅助化疗后,TPS1组CR率13.5%,TPF组CR率11.4%,两组比较差异无统计学意义(P=0.979)。完成同步放化疗后,TPS1组CR率75.7%,TPF组CR率77.1%,两组比较差异无统计学意义(P=0.884)。治疗结束3个月后复查整体(鼻咽+颈部),TPS1组CR率83.8%,TPF组CR率80.0%,两组比较差异无统计学意义(P=0.679)。新辅助化疗后,TPS1组无4级反应,耐受良好,TPS1组1~2级腹胀、腹痛发生率高于TPF组(P<0.05),主要急性毒性反应为血液毒性和消化道反应。整体放化疗结束后,两组均无4级毒性反应发生,主要毒性反应为放射性皮炎、口腔黏膜炎、口干和血液毒性,两组比较差异无统计学意义(P>0.05)。结论与TPF新辅助化疗方案相比,TPS1新辅助化疗方案对局部期鼻咽癌的疗效相当,但安全性更高。

Objective To study the short-terra therapeutic effect and safety of TPS1 and TPF, two neoadjuvant chemotherapy （NC） regi- mens, for treatment of locally advanced nasopharyngeal carcinoma. Methods 72 patients with locally advanced stage nasopharyngeal car- cinoma （NPC） were enrolled from Dec 2015 to Aug 2016, and they all received two cycles of NC, the patients in TPS1 group were given do- cetaxel 60 ·m^-2dl, clsplatin 60 mg·m^-2, dl, and S-1 60 mg·m^-2, d1-14 （two times orally per day）, while the patients in TPF group were given docetaxel 60 mg·m^-2, dl, cisplatin 60 mg·m^-2, dl and 5-fluorouracil （5-FU）, 600 mg·m^-2, dl-5 respectively. After that, all patients were given concurrent chemotherapy （clsplatm 80 mg.m , two cycles） and radiation therapy （CCRT）： PGTVnx： 70.4 Gy/32 f, PGTVnd： 70.4 Gy/32 f, PCTVI： 64 Gy/32 f, PCTV2：57.6 Gy/32 f, PCTV3：50.4 Gy/28 f. Results There was no significance in the complete response （CR） rates between TPS1 and TPF groups （13.5% vs. 11.4%） after two cycles of NC, （75.7% vs. 77.1%） at the end of CCRT, （83.8% vs. 80.0%） at three months after CCRT, respectively. The incidence of abdominal distension and abdominal pain in the TPS1 group were higher （P〈 0.05） than those in the TPF group after NC, the main acute toxic effects were hematologic toxicities and gastrointestinal side effect. Although ra- diation dermatitis, oral mueositis, xerostomia and hematologic toxicities were mostly observed during the CCRT, there was no difference in all complications between the two groups. No grade IV toxicities was found in both two groups. Conclusion Compared with TPF NC regime, TPS1 NC regime had equal efficacy and higher safety for treatment of locally advanced NPC patients.