放疗分别联合多西他赛、顺铂、替吉奥治疗局部晚期鼻咽癌的疗效比较

Comparison of radiotherapy respectively combined with docetaxel,cisplatin,or S-1 in the treatment of locally advanced nasopharyngeal carcinoma

目的:比较多西他赛(TXT)、顺铂(DDP)、替吉奥(S-1)同步放疗治疗晚期鼻咽癌的近期疗效和毒副反应。方法:将99例晚期鼻咽癌患者分为TXT组、DDP组及S-1组,各33例。治疗方案:TXT25mg/m^2静滴,每周1次;DDP40mg/m^2静滴,每周1次;S-140mg/m^2口服,2次/日,d1~14,21天为1周期,共2~3周期。同步IGRT放疗,鼻咽靶区剂量(69.96~73.92)Gy/33f。评价近期疗效及毒副反应。结果:99例患者均可评价疗效。TXT组CR20例、PR11例、SD2例,RR为93.9%;DDP组CR21例、PR10例、SD2例,RR为93.9%;S-1组CR18例、PR12例、SD3例,RR为90.9%。DDP组与TXT组间疗效无统计学差异(P>0.05),S-1组在疗效上稍差于DDP组及TXT组(P<0.05)。主要毒副反应有中性粒细胞减少、胃肠道反应、放射性皮炎及口腔黏膜炎。DDP组中性粒细胞减少和口腔黏膜炎发生率明显高于TXT组(P<0.05),S-1组中性粒细胞减少和口腔黏膜炎发生率明显低于TXT组(P<0.05);胃肠道反应发生率依次为DDP组>S-1组>TXT组(P<0.05)。结论:TXT同步放疗治疗晚期鼻咽癌的近期疗效好,且毒副作用小,可作为晚期鼻咽癌治疗的新选择。

Objective:To investigated the short-term efficacy and side effects of docetaxel(TXT)concurrent radiotherapy,cisplatin(DDP)concurrent radiotherapy and tigeolone(S-1)concurrent radiotherapy for advanced nasopharyngeal carcinoma.Methods:99 patients with advanced nasopharyngeal carcinoma were divided into TXT group,DDP group and S-1 group,with 33 cases in each group.The TXT group was specifically:TXT 25 mg/m^2 intravenous infusion,once a week for 7 times.The DDP group was specifically:DDP 40 mg/m^2 intravenous infusion,once a week for 7 times.The S-1 group was specifically:S-1 40 mg/m^2 orally,2 times/day,d 1~14,21 days for 1 cycle,a total of 2~3 cycles.Radiation therapy was performed with IGRT and the dose of nasopharyngeal target area(69.96~73.92)Gy/33 f.According to the solid tumor efficacy evaluation standard RECIST 1.1,the short-term efficacy was evaluated and the effective rate(RR)was calculated,and the NCI CTC 3.0 standard was used to evaluate the toxic side reaction.Results:99 patients were able to evaluate the efficacy.The TXT group received 20 cases of CR,11 cases of PR and 2 cases of SD,with an RR of 93.9%.The DDP group received 21 cases of CR,10 cases of PR and 2 cases of SD,with an RR of 93.9%.The S-1 group received 18 cases of CR,12 cases of PR,SD 3 cases,and RR was 90.9%.The difference of RR among the three groups was statistically significant(P<0.05).There was no significant difference between the DDP group and the TXT group(P>0.05).The S-1 group was slightly worse than the DDP group and the TXT group(P<0.05).The major toxic side effects included neutropenia,gastrointestinal reactions,radiation dermatitis,and oral mucositis.The incidence of neutropenia and oral mucositis in the DDP group was significantly higher than that in the TXT group(P<0.05).The incidence of neutropenia and oral mucositis in the S-1 group was significantly lower than that in the TXT group(P<0.05).In the incidence of gastrointestinal reactions,DDP group was higher than and S-1 group,S-1 group was higher than TXT group(P<0.05).Conclusion:TXT synchronous radiotherapy has a short-term effect on advanced nasopharyngeal carcinoma with small side effects and can be used as a new treatment for advanced nasopharyngeal carcinoma.