顺铂加卡培他滨诱导化疗治疗局部晚期鼻咽癌的疗效及毒副反应

The efficacy and toxicity of induction chemotherapy with cisplatin and capcitabine for locally advanced nasopharyngeal carcinoma

目的:诱导化疗联合同期放化疗可显著降低局部晚期鼻咽癌的局部进展和远处转移风险,但是目前尚无标准的诱导化疗方案。本文前瞻性研究顺铂加卡培他滨诱导化疗在局部晚期鼻咽癌患者中的疗效及毒副反应。方法:2015年1月至2016年12月期间初治局部晚期鼻咽癌患者56例,均接受PX方案(顺铂80mg/m^2,第1天;卡培他滨1 000 mg/m^2,每日2次口服;每3周为1个周期)诱导化疗3个周期。后续放疗由放疗中心医生安排。3个周期PX化疗后采用世界卫生组织(WHO)疗效评价标准评价疗效。根据"常见不良反应事件评价标准(CTCAE)4.03版本"评估化疗毒副反应。结果:56例患者均顺利完成了3个周期的诱导PX化疗。PX方案化疗3个周期后,鼻咽部和颈部的客观有效率(ORR)分别为78.6%[完全缓解率(CR)为19.6%]和81.5%(CR率为7.4%),鼻咽部+颈部的总体ORR为85.7%(CR率为3.6%)。PX方案化疗期间3-4级白细胞/中性粒细胞减少、贫血、恶心/呕吐和电解质紊乱发生率分别为14.3%、7.1%、5.4%和17.9%,没有发生3-4级手足综合征、腹泻及肾功能损害。没有发生治疗相关的死亡。结论:PX方案诱导化疗治疗局部晚期鼻咽癌疗效好,耐受性好,值得进一步研究。

Objective：Induction chemotherapy（IC） plus concurrent chemoradiotherapy（CCRT） could significantly reduce the hazard of progression and distant metastasis in locally advanced nasopharyngeal carcinoma（LA-NPC）.However,no standard IC regimen is currently available.This study aims to prospectively evaluate the efficacy and toxicity of IC with cisplatin and capcitabine in the treatment of LA-NPC.Methods：From January 2015 to December 2016,fifty-six patients with LA-NPC were enrolled.All patients received 3 cycles of induction PX（cisplatin 80 mg/m^2,day 1.Oral capecitabine 1 000 mg/m^2,twice daily from day 1-14,repeated every 3 weeks）.The following radiotherapy was determined by radiation oncologists.Tumor response was evaluated after 3 cycles of PX according to the World Health Organization（WHO） criteria.Toxicities were gauged based on the Common Terminology Criteria for Adverse Events version 4.03（CTCAE 4.03）.Results：All patients received 3 cycles of induction PX.The objective response rate（ORR） after 3 cycles of PX at the primary site and the neck region were 78.6% [complete response（CR） was 19.6%] and 81.5%（CR was 7.4%） respectively.The combined ORR of the primary site and the neck region was 85.7%（CR was 3.6%）.The incidence of grade 3-4 leukopenia/neutropenia,anemia,nausea/vomiting and electrolyte disturbance during PX were 14.3%,7.1%,5.4% and 17.9%,respectively.No grade 3-4 hand-foot syndrome,diarrhea or renal impairment was observed.There were no treatment-related deaths.Conclusion：Induction PX is highly effective and well tolerated in LA-NPC and warrant further investigation.