不同诱导化疗方案联合同步调强放疗治疗局部晚期鼻咽癌的临床观察

目的:评价不同化疗方案诱导联合同步调强放疗治疗局部晚期鼻咽癌的近期疗效及毒副反应。方法:将不同化疗方案按与调强放疗联合的不同方式分组。其中,PF组70例,采用奈达铂+5-氟尿嘧啶方案诱导化疗联合奈达铂同步调强放疗;TPF组54例,采用紫杉醇+奈达铂+5-氟尿嘧啶方案诱导化疗联合奈达铂同步调强放疗;GP组36例,采用吉西他滨+奈达铂方案诱导化疗联合奈达铂同步调强放疗;奈达铂单药组66例,采用奈达铂同步调强放疗。调强放疗,均为ELEKTA直线加速器(能量为8MV X线)9野调强技术,GTVnx(鼻咽部)总放疗剂量(70.4⁷4.8)GY/(3274.8)GY/(32³4)次,2.2GY/次,GTVnd(颈部淋巴结)总放疗剂量(6434)次,2.2GY/次,GTVnd(颈部淋巴结)总放疗剂量(64⁶8)GY/(3268)GY/(32³4)次,2GY/次。分析4种方案治疗局部晚期鼻咽癌的近期疗效,同时比较其毒副作用。结果:PF组、TPF组、GP组、奈达铂单药组的总有效率分别为82.86%、85.19%、83.33%、81.82%,前3组与奈达铂单药组比较差异无统计学意义(P>0.05);治疗过程中相关毒副反应骨髓抑制发生率TPF组较其他3组明显(P<0.05),但均可耐受。结论:诱导化疗可提高局部晚期鼻咽癌的近期局控率;选择不同的化疗方案其毒副反应也不相同。

Clinical Observation of Different Inductive Chemotherapy Combined with Radiotherapy in the Treatment of Local Advanced Nasopharyngeal Carcinoma

OBJECTIVE： To evaluate short-term efficacy and toxic reaction of different chemotherapy regimens combined with radiotherapy for local advanced nasopharyngeal carcinoma. METHODS： Different chemotherapy regimens combined with radiotherapy were grouped by different combination ways. 70 patients in PF group received nedaplatin＋5-FU inductive chemotherapy combined with nedaplatin radiotherapy; 54 patients in TPF group received paclitaxel＋nedaplatin＋5-FU inductive chemotherapy combined with nedaplatin radiotherapy; 36 patients in GP group received gemcitabine＋nedaplatin inductive chemotherapy combined with nedaplatin radiotherapy; 66 patients in nedaplatin group received nedaplatin radiotherapy. IMRT were 9 IMRT of ELEKTA linear accelerator （energy 8MV X line）, total radiation dose of GTVnx （nasopharynx） of （70.4-74.8） GY / （32-34） times, 2.2GY/time; total radiation dose of GTVnd （cervical lymph node） of （64-68） GY/（32-34） times, 2GY/time. The short-term efficacy of 4 regimens for local advanced nasopharyngeal carcinoma were analyzed and summarized, and toxic side effects were evaluated. RESULTS： Total effective rates of PF group, TPF group, GP group and nedaplatin group were 82.86%, 85.19%, 83.33%, and 81.82%, respectively; there was no statistical significance among 4 groups （P〉0.05）; the incidence of related toxic side effect bone marrow suppression in TPF group was higher than in GP group, PF group and nedaplatin group significantly （P〈0.05）, but all could be tolerated. CONCLUSIONS： Inductive chemotherapy can improve the recent control rate of local advanced nasopharyngeal carcinoma, and toxicity reactions are different in different chemotherapy regimens.