紫杉醇同期放疗治疗鼻咽癌肝转移的疗效观察

Observation of efficacy of paclitaxel with concurrent radiotherapy in the treatment for nasopharyngeal carcinoma patients with liver metastasis

目的探讨周剂量紫杉醇同期放疗治疗鼻咽癌多发肝转移的疗效、预后及安全性.方法收集海南医学院第一附属医院放疗科2016年1月至2018年1月收入的64例鼻咽癌多发肝转移患者,采用随机数字表法随机分为试验组和对照组,各32例.两组患者皆给予肝脏姑息性放疗,中位放疗剂量30 Gy.试验组在放疗开始第1天给予紫杉醇(40 mg/m^2)每周同步化疗,对照组给予顺铂(40 mg/m^2)每周同步化疗,两组均每周连续使用至放疗结束.比较两组患者临床疗效及不良反应.结果随访过程中,试验组失访1例,试验组患者完全缓解(CR)6例(19.4%),部分缓解(PR)9例(29.0%),病情稳定(SD)7例(22.6%),疾病进展(PD)9例(29.0%);对照组失访2例,对照组患者CR4例(13.4%),PR 10例(33.3%),SD 9例(30.0%),PD 7例(23.3%),两组患者临床疗效比较,差异无统计学意义(Z=-0.060,P=0.952).试验组和对照组有效率分别为48.4%(15/31)和46.7%(14/30),差异无统计学意义(χ^2=0.018,P=0.893);两组患者肿瘤控制率分别为71.0%(22/31)和76.7%(23/30),差异无统计学意义(χ^2=0.256,P=0.613).试验组和对照组患者中位生存期分别为9.4个月和8.9个月,1年生存率分别为14.5%和10.0%,差异无统计学意义(χ^2=1.136,P=0.286).不良反应中,试验组患者过敏反应、神经毒性及心血管毒性的发生率分别为18.8%(6/32)、28.1%(9/32)、31.3%(10/32),分别高于对照组的3.1%(1/32)、15.6%(5/32)、15.6%(5/32),差异均无统计学意义(χ^2=2.566,P=0.109;χ^2=1.463,P=0.226;χ^2=2.177,P=0.140);试验组患者的粒细胞下降、血小板下降、红细胞下降、肝肾功能受损的发生率分别为56.3%(18/32)、12.5%(4/32)、15.6%(5/32)、21.9%(7/32),分别低于对照组的68.8%(22/32)、21.9%(7/32)、25.0%(8/32)、28.1%(9/32),差异均无统计学意义(χ^2=1.067,P=0.302;χ^2=0.988,P=0.320;χ^2=0.868,P=0.351;χ^2=0.333,P=0.564);试验组患者的恶心呕吐发生率低于对照组[(40.6%(13/32)∶78.1%(25/32)],差异有统计学意义(χ^2=9.328,P=0.002).结论周剂量紫杉醇同期放疗治疗鼻咽癌多发肝转移疗效与顺铂治疗疗效相当,不良反应可耐受.

Objective To investigate the efficacy,prognosis and safety of weekly paclitaxel with concurrent radiotherapy in nasopharyngeal carcinoma (NPC) patients with multiple liver metastases.Methods A total of 64 NPC patients with multiple liver metastases in First Affiliated Hospital of Hainan Medical University between January 2016 and January 2018 were recruited and randomly divided into experimental group (n =32) and control group (n =32) by the method of random number table.The patients in the two groups were given palliative radiotherapy with a median dose of 30 Gy.The experimental group used weekly paclitaxel (40 mg/m^2) concurrent chemotherapy,cisplatin (40 mg/m^2) in the control group.Paclitaxel and cisplatin were used weekly until the end of radiotherapy.The clinical efficacy and adverse effects between the two groups were compared.Results During the follow-up,1 patient was lost to follow-up in the experimental group,complete remission (CR) in 6 cases (19.4%),partial remission (PR) in 9 cases (29.0%),stable disease (SD) in 7 cases (22.6%) and progressive disease (PD) in 9 cases (29.0%);2 patients were lost to follow-up in the control group,CRin4 cases (13.4%),PR in 10 cases (33.3%),SD in9 cases (30.0%) and PD in7 cases (23.3%).There was no significant difference between the two groups (Z =-0.060,P =0.952).The effective rates of the experimental group and the control group were 48.4%(15/31) and 46.7%(14/30) respectively,and the difference was not statistically significant (χ^2 =0.018,P =0.893);the tumor control rates were 71.0%(22/31) and 76.7%(23/30),with no statistically significant difference (χ^2 =0.256,P =0.613).The median survival time of the experimental group and the control group were 9.4 months and 8.9 months respectively,and the 1-year survival rates were 14.5% and 10.0%,with no significant difference (χ^2=1.136,P =0.286).Among the adverse effects,the incidence rates of allergic reaction,neurotoxicity and cardiovascular toxicity in the experimental group were higher than those in the control group [18.8%(6/32) vs.3.1%(1/32),28.1%(9/32) vs.15.6%(5/32),31.3%(10/32) vs.15.6%(5/32)],with no significant differences (χ^2 =2.566,P=0.109;χ^2 =1.463,P=0.226;χ^2 =2.177,P =0.140).The incidence rates of granulocyte decline,platelet decline,red blood cell decline,and impaired liver and kidney function in the experimental group were lower than those in the control group [56.3%(18/32) vs.68.8%(22/32),12.5%(4/32) vs.21.9%(7/32),15.6%(5/32) vs.25.0%(8/32),21.9%(7/32) vs.28.1%(9/32)],with no significant differences (χ^2 =1.067,P=0.302;χ^2 =0.988,P =0.320;χ^2 =0.868,P =0.351;χ^2 =0.333,P =0.564).The incidence rates of nausea and vomiting was lower than that in the control group [(40.6%(13/32) vs.78.1%(25/32)],with a significant difference (χ^2 =9.328,P =0.002).Conclusion Weekly paclitaxel with concurrent radiotherapy has equivalent efficacy to cisplatin and the adverse effects can be tolerated.