同步放化疗序贯过继免疫细胞治疗局部晚期鼻咽癌的疗效观察

The observation of effect of concurrent chemotherapy radiotherapy and sequential adoptive immunity cells in treatment of locally advanced nasopharyngeal carcinoma

目的:对比采用化疗、放射治疗、细胞因子诱导的杀伤(CIK)细胞+树突状细胞(DC)过继免疫综合治疗局部晚期鼻咽癌与单纯同步放化疗的临床疗效。方法:82例局部晚期鼻咽癌患者随机分为对照组(放化疗)42例和研究组(放化疗+过继性免疫细胞)40例。研究组采用三维适形放疗同步PF方案化疗(顺铂30mg/m^2静脉滴注d_(1 ~ 3),5-氟尿密啶500 mg/m^2静脉滴注d_(1 ~ 5),每28天重复)并序贯CIK细胞与DC,鼻咽部病灶及颈部阳性淋巴结给予放疗总剂量为66~74 Gy,颈部预防性照射给予放疗剂量50 Gy。对照组采用PF方案同步放射治疗,观察疗效、毒副反应和免疫功能。结果:研究组和对照组近期有效率(RR)分别为80.0%、76.2%(P>0.05);中位生存时间(OS)分别39.8个月和36.3个月(P>0.05),而中位无进展生存时间(PFS)分别为12.9个月、10.2个月,差异有统计学意义(P=0.045)。观察组免疫功能明显高于对照组,两组毒副反应主要为血液学毒性、黏膜炎,差异无统计学意义(P>0.05)。结论:同步放化序贯CIK细胞和DC可延长患者的中位无进展生存时间,且未增加不良反应,可作为局部晚期鼻咽癌治疗方法之一。

Objective：To evaluate the effects of chemotherapy radiotherapy and cytokine - induced killers （CIK） cell and dendritic cell（DC） therapy for locally advanced nasopharyngeal carcinoma（LANPC）. Methods：82 patients with LANPC were randomly divided into study group （chemotherapy ＋ radiotherapy ＋ CIK ＋ DC）（40 cases）and con- trol group（ chemotherapy ＋ radiotherapy）（42 cases ）. Study group adopted PF scheme （5 -FU 500 mg/m2 iv d1-5, cisplatin 30mg/m2 iv d1-3 ;28 days was a cycle）chemotherapy concurrent Three - dimensional conformal radiotherapy and sequential CIK cell and DC. Nasopharyngeal lesions and positive lymph node were given a total amount of 66 - 74 Gy and prophylactic neck radiation was given the amount of 50 Gy. Control group adopted PF scheme chemotherapy concurrent radiotherapy. The effect, toxicant, immunological function were observed. Results：There were no significant differences in the objective response rate（ 80.0% vs 76.2%, P 〉 0. 05 ）. The median overall survival（OS） of study group and control group were 39.8 months and 36.3 months （P 〉 0. 05 ）. The progression -free survival （PFS） of study group was longer than control group （ 12.9 months vs 10.2 months, P = 0. 045 ）. Immunological function of study group were higher of control group （ P 〈 0.05 ）. The main side effects in two groups were hematologic toxicities and mucositis with no statistical difference （ P 〉 0.05 ）. Conclusion ： Concurrent chemo - radiotherapy sequential a- doptive immunity cells could prolong median PFS of patients in the treatment of locally advanced nasopharyngeal car- cinoma.