顺铂单周与三周方案同期联合调强放射治疗局部晚期鼻咽癌的不良反应与疗效的比较

Comparison of toxicities and treatment outcome of weekly and triweekly cisplatin concurrent with intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma

目的 比较顺铂单周或三周治疗方案同步调强放疗对局部晚期鼻咽癌患者的血液学、黏膜不良反应及疗效的差异.方法 回顾性分析2009年10月至2013年12月收集的148例初治局部晚期鼻咽癌患者资料,所有患者均接受2周期诱导化疗后行调强放疗联合顺铂单药治疗模式,其中75例患者接受顺铂单周治疗方案,73例患者接受顺铂三周治疗方案.采用χ^2检验比较两组的血液学不良反应、黏膜不良反应、肿瘤缓解率和预后的差异.两组间的生存率进行Kaplan-Meier法计算并行log-rank检验.结果 顺铂单周组及顺铂三周组化疗的平均治疗周期数为3.64个（20％达5个周期）和1.86个（86％达2个周期）.顺铂单周组对比顺铂三周组的Ⅰ、Ⅱ度白细胞减少的患者比例的差异均有统计学意义（31％vs.51％、35％ vs.19％,χ^2=6.150、4.500,均P＜0.05）;其他血液学不良反应两组间的差异均无统计学意义.两组黏膜反应差异无统计学意义（χ^2=0.137,P=0.934）.放疗结束后6个月顺铂单周与顺铂三周组肿瘤的完全缓解率分别为98.7％和98.6％,单周组和三周组5年生存率分别为77.84％和79.97％,两组间差异无统计学意义（χ^2=3.78,P=0.059）;5年无病生存率分别为67.96％和69.10％（χ^2=1.25,P=0.27）,5年无局部复发生存率分别为88.76％和86.96％（χ^2=0.43,P=0.56）,5年无区域复发生存率分别为91.49％和90.84％（χ^2=0.18,P=0.67）,5年无远处转移生存率分别为77.86％和78.90％（χ^2=0.31,P=0.56）,两组间差异均无统计学意义.结论 局部晚期鼻咽癌在接受2周期诱导化疗后,顺铂三周联合放疗方案在血液学不良反应方面优于顺铂单周治疗方案,两组在黏膜相关不良反应以及疗效上未见显著差异,顺铂三周组较顺铂单周组具有较好的治疗依从性.

Objective To evaluate the rates of hematologic and mucosal toxicities and treatment outcome of a weekly cisplatin （QW） and triweekly cisplatin （Q3W） regimens concurrent with intensitymodulated radiotherapy （IMRT） for local regionally advanced nasopharyngeal carcinoma （NPC）.Methods A total of 148 patients with biopsy-proven NPC staged at Ⅲ to ⅣB were retrospectively enrolled from October 2009 to December 2013 in this study.Among all patients,75 and 73 received QW and Q3W cisplatin chemotherapy regimens concurrent with IMRT,respectively.All patients received neoadjuvant chemotherapy.The χ^2-test was used to compare clinical characteristics of the patients and hematologic and mucosal toxicities.Tumor response and survival rates were estimated through the Kaplan-Meier method with log-rank test.Results The mean total cycles of the cisplatin regimen was 3.64 in the QW group with 15 patients（20%） reaching five cycles and 1.86 in the Q3W group with 86% reaching two cycles.Grades 1,2 leucopenia were 31% vs.51% and 35% vs.19%,respectively,in the QW and Q3W groups.The two groups showed significant differences in Grades 1 and 2 leucopenia（χ^2=6.150,4.500,both P〈0.05） but not for other hematological toxicities and mucositis（χ^2=0.137,P=0.934）.The complete remission rates at 6 months after radiotherapy for the QW and QW3 groups were 98.7% and 98.6%,respectively.The 5-year estimated overall survival,disease-free survival,local recurrence-free survival,regional recurrence-free survival,and distant metastasis-free survival rates of the QW and Q3W groups were 77.84% vs.79.97%（χ^2=3.78,P=0.059）,67.96% vs.69.10% （χ^2=1.25,P=0.27）,88.76% vs.86.96% （χ^2=0.43,P=0.56）,91.49% vs.90.84% （χ^2=0.18,P=0.67）,and 77.86% vs.78.90% （χ^2=0.31,P=0.56）,respectively,and were not significantly different between the two groups.Conclusions Hematological toxicities associated with the QW3 regimen concurrent with IMRT for locally advanced NPC were milder than those associated with the QW weekly regimen.Mucositis and treatment outcome did not significantly differ between the two groups.Patients showed better compliance with the Q3W regimen than with the QW regimen.