多西他賽同步放、化療治療局部晚期鼻咽癌的療效觀察

1、多西他賽同步放、化療治療局部晚期鼻咽癌的療效觀察 07-12-01 11:35:00 編輯：studa20 作者：陳群，丁純志，趙景勝，徐朝久，涂向陽，龍劍，向志碧【關(guān)鍵詞】 鼻咽癌；同步放化療；多西他賽；療效；毒副作用摘 要 目的：觀察多西他賽同步放、化療治療晚期鼻咽癌的臨床療效和毒副作用，方法：132例局部晚期鼻咽癌患者隨機(jī)分為兩組，一組66例為多西他賽同步化療+放療（治療組），另一組66例為PF（DDP+5Fu）方案同步化療+放療（對照組）。結(jié)果：在放療腫瘤量DT50Gy時治療組鼻咽病灶消退率、頸部轉(zhuǎn)移灶消退率分別為65.2%、69.7%，對照組分別為59.1%、63.6%（P0.05）

2、。全程放療結(jié)束后3個月治療組鼻咽病灶消退率、頸部轉(zhuǎn)移灶消退率分別為95.5%、93.9%，對照組分別為87.8%、86.4%（P0.05）。中位隨訪35個月（11個月60個月），3 a總生存率、中位生存時間治療組為81.9%、53個月，對照組為75.3%、52個月（P0.05），3 a無進(jìn)展生存率及中位無進(jìn)展生存時間治療組為70.2%、40月，對照組為64.0%、39個月（P0.05）。3 a局部控制率、中位無復(fù)發(fā)生存期分別是76.5%、52個月和70.7%、45個月（P0.05）。對照組的毒副作用如惡心、嘔吐、骨髓抑制均較治療組明顯，差異有顯著性（P0.05)。結(jié)論：多西他賽同步放化療與PF

3、方案同步放化療治療晚期鼻咽癌，生存率及局部控制率相近，前者毒副作用較輕。關(guān)鍵詞 鼻咽癌；同步放化療；多西他賽；療效；毒副作用Concurrent Radiotherapy and Chemotherapy with Docetaxel For LocaladvancedNasopharyngeal CarcinomaAbstract：Objective To evaluate the efficacy and sideeffects of concurrent radiotherapy and chemotherapy with Docetaxel for localadvanced naso

4、pharyngeal carcinoma(NPC).Methods 132 patients with localadvanced NPC were randomized into two groups:66 cases in treatment group were treated concurrent radiotherapy and chemotherapy(CCRT) with Docetaxel whereas 66 cases in control group received CCRT with PF（cisplatin and fluorouracil）.Results The

5、 dose of radiation was 50 Gray (Gy) the nasopharyngeal lesion remission rate and cervical metastasis remission rate were 65.2%,69.7% in treatment group and 59.1%,63.6% in control group（P0.05）.3 months after radiotherapy the nasopharyngeal lesion remission rate and cervical metastasis remission rate

6、were 95.5%,98.5% in treatment group and 87.8%,86.4 %in control group（P0.05）.With a median follow up of 35 months(rang from 1160 months),the overall survival rate at 3year was 81.9%,the median survival time was 53 months in treatment group,whereas in control group they were 75.3%,52 months respective

7、ly（P0.05）.The 3year progressfree survival rate and median progressfree survival time was 70.2%,40 months in treatment group and 64.0%,39months in control group（P0.05）.The 3year locoregional control rate and median relapsefree survival time were 75.6%,52 months in treatment group and 70.7%,45 months

8、in control group（P0.05）.Sideeffects such as nausae,vomit and myelosuppression were more severe in control group than that in treatment group （P0.05).Conclusion Concurrent radiotherapy and chemotherapy with Docetaxel is a effect regimen for localadvanced nasophar yngeal carcinoma comparing with PF re

9、gimen,with similar survival rate and locoregional control rate but relatively lower sideeffects.Key words：Nasopharyngeal carcinoma;Concurrent radiotherapy and chemotherapy;Docetaxel;Efficacy;Toxicity近年來，國內(nèi)外許多研究表明13，同步放化療治療局部晚期鼻咽癌，能提高腫瘤的局部控制率與長期生存率，順鉑、5Fu是常用聯(lián)合方案。多西他賽作為新型抗腫瘤藥物，實驗研究表明4，其對鼻咽癌有明顯的放射增敏作用。

10、2000年8月至2002年8月我們采用多西他賽同步放化療治療局部晚期鼻咽癌，并與PF方案同步放化療進(jìn)行比較，觀察其療效和毒副作用，現(xiàn)報道如下。1 資料與方法1.1 病例選擇 入組標(biāo)準(zhǔn)：初診經(jīng)病理確診為低分化鱗癌、既往未行任何抗癌治療，臨床分期、a期（福州92分期），年齡20歲65歲，KPS評分70分，WBC4109/L，Hb110 g/L，肝、腎功能正常，心電圖正常。1.2 臨床資料 治療組男性43例，女性23例，平均年齡為54.5歲（20歲63歲），期48例，a期18例。對照組：男性45例，女性21例，平均年齡50歲（22歲65歲），期47例，a期19例，兩組患者一般資料差異無顯著性，具有可

11、比性。1.3 治療方法 治療組：多西他賽40 mg溶入生理鹽水200 ml靜脈點滴1 h，休息6 h后進(jìn)行放療?；熐耙惶斓厝姿深A(yù)處理，8 mg口服2次/d，連用3 d。從放療開始，每周一次，連用6次7次，直至放療結(jié)束。對照組：順鉑20 mg靜脈點滴1 d5 d，F(xiàn)u 0.5 g靜脈點滴1 d5 d，于放療第1周、第4周各化療一周期兩組均常規(guī)放療，6MVX線外照射，鼻咽部DT6874 Gy，每次2 Gy，每周5次。顱底廣泛侵犯者部分加量至DT80 Gy。頸部預(yù)防量DT50 Gy，治療量DT60 Gy74 Gy。1.4 療效及毒副作用評價 每周查血常規(guī)1次2次，化療前查肝、腎功能，每周記錄鼻咽腫瘤及頸部淋巴結(jié)變化和各項毒副作用，放療量DT50 Gy和全程放療結(jié)束后3個月復(fù)查鼻咽CT、頸部彩色B超。按WHO標(biāo)準(zhǔn)評價療效，并按WHO毒性分級標(biāo)準(zhǔn)評價毒副作用。1.5 隨訪情況