调强放疗联合时辰化疗治疗局部进展期鼻咽癌的近期疗效及不良反应

目的 比较时辰化疗与常规化疗联合调强放疗在局部进展期鼻咽癌患者治疗过程中的不良反应、免疫功能、近期疗效。方法 选取2015年7月至2017年4月在贵州医科大学附属肿瘤医院初治局部进展期鼻咽癌患者159例，采用简单随机分组法，前瞻性将159例初治局部进展期鼻咽癌患者随机分为时辰化疗组与常规化疗组，前者采用时辰化疗模式给药，后者采用常规模式给药，两组均采用调强放射治疗，评价近期疗效及观察不良反应。结果 时辰化疗组与常规化疗组近期疗效完全缓解（CR）、部分缓解（PR）、稳定（SD）、进展（PD）差异无统计学意义（P>0.05），两组有效率（CR+PR）差异无统计学意义（P>0.05）；时辰化疗组的白细胞减少（Z=-2.222，P<0.05）、中性粒细胞减少（Z=-1.999，P<0.05）、呕吐（Z=-2.298，P<0.05）、口腔黏膜炎（Z=-3.571，P<0.05）发生率低于常规化疗组，差异有统计学意义；时辰化疗组CD16+56+淋巴细胞计数高于常规化疗组（Z=-2.332，P<0.05）。结论 时辰化疗作为一种新的治疗模式，与调强放疗联合可在不降低临床疗效的同时减轻治疗相关不良反应的发生率及严重程度，减轻免疫抑制，值得临床推广及应用。

Short-term efficacy and adverse events of intensity-modulated radiotherapy combined with chronomodulated chemotherapy for locally advanced nasopharyngeal carcinoma

Objective To compare the adverse events, immune status, and short-term efficacy between chronomodulated chemotherapy (CCR) and routine chemotherapy (RCR) combined with intensity modulated radiotherapy (IMRT)in the treatment of patients with locally advanced nasopharyngeal carcinoma. Methods A total of 159 patients with newly diagnosed locally advanced nasopharyngeal carcinoma were randomized into the CCR group and the RCR group to evaluate the short-term efficacy and adverse events. Results No significant difference was found in CR, PR,SD, and PD between the CCR group and the RCR group (P>0.05), and no significant difference was observed in the response rate (CR+PR) between the two groups (P>0.05). The incidence of leukopenia(Z=-2.222, P<0.05), neutropenia(Z=-1.999,P<0.05), vomiting(Z=-2.298, P<0.05), and oral mucositis(Z=-3.571, P<0.05)of the CCR group was lower than those of the RCR group with statistical significance. The CD16+56+ lymphocyte cell count was higher in the CCR group than that in the RCR group(Z=-2.332,P<0.05). Conclusions As a novel invention, CCR combined with IMRT can reduce the incidence and severity of treatment-related adverse events and improve immune status without diminishing clinical efficacy, therefore deserving clinical application.