TPF方案时辰诱导化疗联合同步放化疗治疗局部晚期鼻咽癌的近期疗效观察

Clinical observation of TPF chrono-chemotherapy with concurrent chemoradiation in the treatment of locally advanced nasopharyngeal carcinoma

目的探讨TPF时辰诱导化疗联合同步放化疗治疗局部晚期鼻咽癌的近期疗效。方法将117例局部晚期鼻咽癌患者采用随机数字表法分为对照组(57例)和观察组(60例),对照组给予DTX 75 mg/m^2静滴1 h d1(DDP前使用);DDP 75 mg/m^2静滴d1;5-Fu 750 mg/(m^2·d)持续静滴d1～d5,21 d为一个周期,共2周期。观察组DTX 75 mg/m^2,静滴,d1。DDP 75 mg/m^2,分5 d完成静滴给药,每天10:00～22:00。5-Fu 750 mg/(m^2·d),d1～d5,持续静滴,每天22:00～10:00。21 d为一个周期,共2个周期。2组化疗后评价有效者行三维适形调强放疗,同期放疗DDP 80 mg/m^2,d1～d3,静滴,21 d为一个周期,共2周期。分别于治疗前后检测2组患者血清巨噬细胞炎性蛋白-3α(MIP-3α)与半胱氨酸蛋白酶抑制剂A(cystatin A)表达水平并进行临床疗效评定。结果观察组患者鼻咽部肿瘤控制和颈部淋巴结控制有效率为94.74%,92.98%,对照组为92.72%,90.90%,差异无统计学意义(P> 0.05);2组患者血清MIP-3α和cystatin A表达水平均显著低于同组治疗前(P<0.05)。观察组生存质量改善情况显著高于对照组,且观察组不良发生率低于对照组(P<0.05)。结论 TPF方案时辰诱导化疗联合同步放化疗治疗局部晚期鼻咽癌患者近期疗效好,且毒副反应较小,患者耐受性好。

Objective To investigate the clinical efficacy and safety of TPF chrono-chemotherapy with concurrent chemoradiation in the Treatment of locally advanced nasopharyngeal carcinoma.Methods117patients with locally advanced nasopharyngeal carcinoma were randomly divided into control group and observ-ation group.Control group was treated with DTX75mg/m2,infusion,d1;DDP75mg/m^2,infusion,d1;and5-Fu750mg/(m^2·d),continuous infusion,d1~d5,for three courses.Observation group was treated with DTX,75mg/m^2,i.v.infusion,d1;DDP,75mg/m^2,bolus infusion from10:00to22:00,d1~d5;and5-Fu750mg/(m^2·d)bolus infusion from22:00to10:00,d1~d5,with21days each cycle.Patients who obtained therapecutic efficacy via induction chemotherapy were provided with intensity-modulated radiotherapy as a concurrent radiotherapy and chemoth-erapy(DDP80mg/m^2,infusion,d1~d3,with21days each cycle and a total of two courses).Acute and late toxicities were graded according to the Common Terminology Criteria for Adverse Events v3.0scoring criteria.Tumor response was evaluated using2000Response Evaluation Criteria in Solid Tumors criteria.Serum macrophage inflammatory protein-3α(MIP-3α)and cystatin A levels were compared in2groups before and after treatment12months were observed.Results After treatment,The efficient rate of nasopharyngeal carcinoma was94.74%and of cervical lymph node was92.98%in observation group.By contrast,the efficient rate of nasopharyngeal carcinoma was92.72%,and of cervical lymph node90.91%in control group respectively.Results showed no significant difference in the complete response efficient rate of both nasopharyngeal carcinoma and cervical lymph node with two groups(P>0.05).The serum levels of MIP-3αand cystatin A in two groups were significantly lower than those before(P<0.05).The improvement of quality of life in the observation group was better than that in the control group(P<0.05).There was statistical significance in the incidence of ADR between2groups(P<0.05).The vomit rate was29.82%in observation group,which was less than the data was50.91%in control group(P<0.05).Conclusions TPF chrono-chemotherapy with concurrent chemoradiation in the treatment of locally advanced nasopharyngeal carcinoma has a great short-term effects and less side effects,which is an effective,tolerable and safe comprehensive treatment scheme.