晚期口腔鳞状细胞癌术前TOF与TPF方案诱导化疗的临床疗效比较

目的 比较晚期口腔鳞状细胞癌术前多西他赛、奥沙利铂联合氟尿嘧啶方案（TOF方案）与 多西他赛、顺铂联合氟尿嘧啶方案（TPF方案)诱导化疗的疗效及不良反应。方法 将67例晚期口腔鳞状细胞癌患者随机分为TOF组35例和TPF组32例。TOF组：多西他赛75 mg/m²，d1；奥沙利铂 130 mg/m²，d1；氟尿嘧啶750 mg/m²，d1～d5。TPF组：多西他赛75 mg/m²，d1；顺铂75 mg/m²，d1；氟尿嘧啶750 mg/m²，d1～d5。两组均静脉滴注，19 d为一个周期，2个周期化疗后评价疗效及不良反应，随访中位生存时间。结果 TOF组和TPF组总有效率分别为65.71%（23/35）和62.50%（20/32），中位生存期分别为31个月（95%CI：21.7~40.3）和33个月（95% CI：25.8~40.1），两组总有效率和中位生存期比较差异均无统计学意义（P＞0.05）。TOF组骨髓抑制、胃肠道反应、肾毒性反应等发生率明显低于TPF组（P＜0.05），周围神经毒性发生率明显高于TPF组（P＜0.05），脱发发生率两组差异无统计学意义（P＞0.05）。结论 晚期口腔鳞状细胞癌患者术前采用TOF 和TPF 方案诱导化疗的疗效相当，患者均可耐受，但TOF方案不良反应较轻，可作为晚期口腔鳞状细胞癌较理想的术前诱导化疗方案。

The clinical comparative observation of preoperative induction chemotherapy with TOF or TPF regimen for advanced oral squamous cell carcinoma

Objective To compare the efficacy and adverse reaction of two preoperative inductive chemotherapy regimens：TOF regimen（docetaxel combined with oxaliplatin and fluorouracil） versus TPF regimen（docetaxel combined with cisplatin and fluorouracil） for advanced oral squamous cell carcinoma（OSCC）. Methods 67 cases of OSCC were divided randomly into TOF group （n=35） and TPF group（n=32）. The TOF regimen involved docetaxel at 75 mg/m2，ivgtt，d1；oxaliplatin at 130 mg/m²，ivgtt，d1 and fluorouracil at 750 mg/m²，ivgtt，d1-d5. The TOF regimen involved docetaxel at 75 mg/m²，ivgtt，d1；cisplatin at 130 mg/m²，ivgtt，d1 and fluorouracil at 750 mg/m²，ivgtt，d1-d5，on a 19-day cycle. After 2 cycles，efficacy，safety and median  progression-free survival（mPFS）were compared between the two treatment groups. Results Overall response rate was 65.71% in the TOF group and 62.50% in the TPF group（P<0.05）. mPFS was 31（95%CI：21.7-40.3） months in the TOF group and 33（95% CI：25.8-40.1） months in the TPF group（P<0.05）. Patients in the TOF group showed significantly lower rates of bone marrow aplasia，gastrointestinal reactions and renal toxicity（P＜0.05），and showed significantly higher rate of periphery neurotoxicity（P＜0.005）. However，the rate of alopecia was similar between the two groups（P＞0.05）. Conclusion TOF regime show a similar short-time outcome and mPFS compared with TPF regime in preoperative induction chemotherapy for patients with advanced OSCC. However，TOF regime show a better favorable safety profile and may be reasonably tolerated by most patients.