紫杉醇联合奈达铂诱导化疗后同步放化疗治疗局部晚期鼻咽癌52例

Paclitaxel and nedaplatin neoadjuvant chemotherapy followed by concurrent chemoradiation for locoregionally advanced nasopharyngeal carcinoma:a clinical study of 52 cases

目的探讨紫杉醇联合奈达铂(TP)诱导化疗序贯同步放化疗与单纯同步放化疗治疗局部晚期鼻咽癌的疗效和不良反应。方法选取安徽医科大学附属安庆医院从2012年1月至2014年12月首诊为局部晚期鼻咽癌的病人102例,按随机数字表法分组,对照组50例:对病人行单纯同步放化疗;试验组52例:对病人行TP诱导化疗序贯同步放化疗,比较两组的近、远期疗效及不良反应。结果试验组完全缓解41例,部分缓解9例,总有效率为96.2%(完全缓解:78.9%;部分缓解:17.3%),对照组完全缓解26例,部分缓解18例,总有效率为88.0%(完全缓解:52.0%;部分缓解:36.0%),两组间疗效比较采用秩和检验,差异有统计学意义(Uc=8.228,P=0.004)。试验组治疗后出现白细胞减少、贫血、血小板减少、肝肾功能损害、口腔黏膜炎、皮炎、恶心呕吐反应发生率与对照组均差异无统计学意义(P>0.05)。试验组随访1、2、3年总生存率分别为100.0%、93.7%、84.7%,无疾病进展生存率分别为98.0%、91.6%、80.4%,对照组随访1、2、3年总生存率分别为94.0%、85.7%、70.1%,无疾病进展生存率分别为88.0%、75.1%、67.4%,试验组1、2、3年总生存率及无疾病进展生存率显著高于对照组,差异有统计学意义(P<0.05)。结论相比单纯同步放化疗,紫杉醇联合奈达铂新辅助化疗后序贯同步放化疗治疗局部晚期鼻咽癌的近、远期疗效更佳,且不良反应可耐受。

Objective To investigate the efficacy and adverse reactions of paclitaxel and nedaplatin(TP)neoadjuvant chemotherapy followed by concurrent chemoradiation and simple concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma.Methods A total of 102 patients initially diagnosed as locally advanced nasopharyngeal carcinoma in Anqing Hospital Affiliated to Anhui Medical University from January 2012 to December 2014 were enrolled in the study and assigned into two groups according to random number table.The control group(n=50)was treated with simple concurrent chemoradiotherapy,while the experimental group(n=52)was treated with TP-induced chemotherapy followed by concurrent chemoradiotherapy.The short-term and long-term effects and adverse reactions of the two groups were compared.Results In the experimental group,41 patients had complete remission and 9 patients had partial remission.The total effective rate was 96.2%(total remission:78.9%;partial relief:17.3%).In the control group,26 patients had complete remission and 18 patients had partial remission.The total effective rate was 88.0%(total remission:52.0%;partial relief:36.0%).The rank-sum test results showed that the difference in efficacy between the two groups was statistically significant(U c=8.228,P=0.004).In terms of side effects,there was no significant difference in the incidence rates of leukopenia,anemia,thrombocytopenia,hepatic and renal insufficiency,mucositis,dermatitis and vomiting(P>0.05).The 1,2,3-year total survival rates of the experimental group were 100.0%,93.7%and 84.7%,respectively.The 1,2,3-year total survival rates of the control group were 94.0%,85.7%and 70.1%,respectively.The 1,2,3-year progression-free survival rates of the experimental group were 98.0%,91.6%and 80.4%,respectively.The 1,2,3-year progression-free survival rates of the control group were 88.0%,75.1%and 67.4%,respectively.The 1,2,3-year total survival rates and progression-free survival rates in the experimental group were significantly higher than the control group;the differences between the 2 groups were significant(P<0.05).Conclusion Sequential concurrent chemoradiotherapy with paclitaxel and nedaplatin in the treatment of locally advanced nasopharyngeal carcinoma has better short-term and long-term efficacy and tolerable adverse side effects than simple concurrent chemoradiotherapy.