不同剂量每周顺铂方案在鼻咽癌同步放化疗中的疗效观察

Efficacy of Different Dosages of Weekly Cisplatin Regimen in Concurrent Chemoradiotherapy for Nasopharyngeal Carcinoma

目的观察低于标准剂量(40 mg/m^(2)/周)的每周顺铂方案在鼻咽癌同步放化疗中的疗效。方法选取2011年6月至2016年1月成都医学院第一附属医院肿瘤科收治的88例Ⅲ及Ⅳa期鼻咽癌患者作为研究对象,按同步放化疗期间采用不同顺铂剂量随机分为A、B两组,A组顺铂剂量20 mg/m^(2)/周(n=43),B组30 mg/m^(2)/周(n=45)。两组均采用同步放化疗序贯辅助化疗的治疗模式,放疗均采用常规分割,计划靶区70 Gy,同步治疗结束后予3个周期顺铂联合氟尿嘧啶方案化疗,观察两组按计划完成同步化疗次数、不良反应及疾病进展时间(DFS)、总生存期(OS)、治疗有效率(RR)、疾病控制率(DCR)等指标。结果 A组完成化疗的平均次数较B组多(P<0.05)。治疗完成后,两组RR、DCR、DFS及OS比较,差异无统计学意义(P>0.05)。B组化疗相关Ⅲ/Ⅳ度不良反应例数、Ⅲ/Ⅳ度白细胞降低例数及Ⅰ/Ⅱ度便秘例数均较A组多(P<0.05)。结论单药顺铂每周方案剂量为20 mg/m^(2)时,患者更易耐受同步放化疗疗程,且较30 mg/m^(2)的剂量没有降低治疗效果。

Objective To observe the efficacy of weekly cisplatin regimen with a lower than standard dosage(40 mg/m^(2)/week) in concurrent chemoradiotherapy for nasopharyngeal carcinoma.Methods A total of 88 patients with clinical stage Ⅲ and Ⅳa nasopharyngeal carcinoma admitted to the oncology department of the First Affiliated Hospital of Chengdu Medical College from June 2011 to January 2016 were enrolled and randomly divided into group A(n=43, cisplatin 20 mg/m^(2)/week) and group B(n=45, cisplatin 30 mg/m^(2)/week). Patients in both groups received concurrent chemoradiotherapy followed by adjuvant chemotherapy. Radiotherapy was performed with common fraction, and with the planned target area(PTV) of 70 Gy. Three cycles of cisplatin combined with fluorouracil regimen chemotherapy were administrated after concurrent chemoradiotherapy. Indicators of observation includes: number of cycles of concurrent chemotherapy successfully finished as planned, adverse events, disease-free survival(DFS), overall survival(OS), response rate(RR) and disease-control rate(DCR), etc. Results The mean number of cycles of chemotherapy finished in group A was more than that in group B(P<0.05). After treatment, there was no significant difference in RR, DCR, DFS and OS between the two groups(P>0.05). Compared with group A, group B had more cases of grade Ⅲ/Ⅳ chemotherapy-related adverse events, grade Ⅲ/Ⅳ leukopenia and grade Ⅰ/Ⅱconstipation(P<0.05). Conclusion The dosage of 20 mg/m^(2)/week of cisplatin, compared with the dosage of 30 mg/m^(2)/week of cisplatin, is better for patients to tolerate the entire course of concurrent chemoradiotherapy, and does not lower the therapeutic effect.