局部晚期鼻咽癌TPF方案诱导化疗加紫杉醇或顺铂同期IMRT疗效分析

目的 分析局部晚期鼻咽癌TPF诱导化疗加紫杉醇或顺铂同期IMRT的疗效。

Efficacy of induction chemotherapy with TPF plus concurrent IMRT with paclitaxel or cisplatin in treatment of locally advanced nasopharyngeal carcinoma

Objective To evaluate the efficacy of docetaxel, cisplatin, and 5-fluorouracil (TPF)-based induction chemotherapy plus concurrent intensity-modulated radiotherapy (IMRT) with paclitaxel or cisplatin in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Methods From 2008 to 2012, 263 patients with locally advanced NPC were enrolled as subjects. A prescribed dose of 69.96-73.92 Gy in 33 fractions was applied to the primary nasopharyngeal gross tumor volume and the positive lymph nodes, 60.06 Gy in 33 fractions to the clinical target volume, and 50.96 Gy in 25 fractions to the negative lymphatic drainage volume. All patients were treated with two or three cycles of TPF-based induction chemotherapy (docetaxel 75 mg/m²;cisplatin 75 mg/m²;5-fluorouracil 750 mg/m²·d^－1), followed by two cycles of concurrent IMRT with paclitaxel (135 mg/m² on days 1 and 22) for 128 patients and with cisplatin (100 mg/m² on days 1 and 22) for 135 patients. The survival rates were calculated with the Kaplan-Meier method and analyzed by the log-rank test. Multivariate prognostic analysis was performed using the Cox regression model. Results With a sample size of 42 patients, the 5-year overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS) were 81.6%, 76.1%, 92.3%, 88.5%, and 80.4%, respectively. Patients treated with induction chemotherapy plus concurrent IMRT with cisplatin had significantly higher OS (93.5% vs. 74.7%, P=0.035), PFS (80.1% vs. 72.7%, P=0.034), LRFS (95.9% vs. 88.8%, P=0.020), and DMFS (83.5% vs. 77.5%, P=0.033) than those treated with concurrent IMRT with paclitaxel. Due to concurrent chemoradiotherapy, the incidence rates of grade ≥3 leucopenia, gastrointestinal reactions, oral mucositis, and radiodermatitis were 33.1%, 11.8%, 26.3%, and 11.1%, respectively. The incidence rates of grade 1 xerostomia, grade 2 xerostomia, grade 3 hearingloss, and grade 3 trismus were 50.3%, 12.6%, 3.4%, and 3.3%, respectively. ConclusionsCompared with TPF-based induction chemotherapy plus concurrent IMRT with paclitaxel, concurrent IMRT with cisplatin yields higher OS, PFS, LRFS, and DMFS as well as tolerable acute adverse reactions in the treatment of locally advanced NPC.