TPF方案诱导化疗对局部N晚期鼻咽癌的近期疗效

 目的　比较1个疗程TPF方案和2个疗程PF方案作为诱导化疗对局部N晚期鼻咽癌的近期疗效和患者不良反应。方法　收集2007年1月至2008年12月初治的47例接受过诱导化疗的局部N晚期鼻咽癌患者，其中采用1个疗程TPF诱导化疗方案26例，采用2个疗程PF诱导化疗方案21例； TPF方案使用多西紫杉醇（Docetaxel，TAX，商品名：泰素帝） 60 mg／m2，静脉滴注，第1天；顺铂（DDP）80 mg／m2，静脉滴注，第1天；5-氟尿嘧啶（5-Fu） 800 mg／m2，第1天至第4天，静脉泵注。PF方案使用DDP 100 mg／m2，静脉滴注，第1天；5-Fu 1000 mg／m2，第1天至第4天，静脉泵注；两组均为3周方案。随后两组均采用DDP（30 mg／m2，每周方案）单药为基础的同期放化疗。观察比较两组患者的近期疗效和不良反应。结果　试验组诱导化疗后鼻咽部病灶有效率（CR+PR）57.7 %；颈部有效率69.2 %，对照组2个疗程PF方案诱导化疗后鼻咽部病灶有效率66.7 %；颈部有效率71.4 %（P＞0.05）。治疗后3个月试验组鼻咽部病灶和颈部淋巴结CR率分别为 92.3 %和88.7 %，而对照组鼻咽部病灶和颈部淋巴结CR率分别为 100.0 %和90.5 %（P＞0.05）。试验组治疗不良反应主要是中性粒细胞减少和脱发。结论　1个疗程TPF诱导化疗对局部N晚期鼻咽癌可取得较好的局部控制率，中性粒细胞减少是主要的治疗毒性。

Short-term effects of induction chemotherapy with one cycle TPF regimen in the N advanced local nasopharyngeal carcinoma

Objective To compare the short-term effects and toxicity of one cycle of TPF regimen induction chemotherapy with that of two cycles of PF regimen induction chemotherapy in the N advanced local nasopharyngeal carcinoma (NPC). Methods A total of 47 patients initially treated with N advanced local NPC without distant metastasis from Jan 2007 to Dec 2008 were enrolled in this study. The TPF chemotherapy regimen was administered as follows: TAX 60 mg/m2, i.v. infusion on day 1st, cisplatin 80 mg/m2, i.v. infusion on day 1st and 5-Fu 800 mg/m2, bolus infusion in 96 hours on day lst-4th. The PF chemotherapy regimen was as follows: cisplatin 100 mg/m2, i.v. infusion on day 1 and 5-Fu 1000 mg/m2, bolus infusion in 96 hours on day lst-4th. Twenty-six patients received one cycle of TPF regimen and 21 patients received two cycles of PF regimen, with 21 days each cycle and a total of 3 courses in each group, then chemoradiotherapy with cisplatin 30 mg/m2 (weekly) was followed. Results The short-term efficacy was no significant difference between two groups, after one cycle TPF chemotherapy, the CR+PR rates of primary site and lymph nodes were 57.7 % and 69.2 %, respectively, while after two cycles PF chemotherapy in control group, those were 66.7 % and 71.4 %, respectively (P>0.05). In 3 months after treatment, the CR rates of primary site and lymph nodes in TPF group were 92.3 % and 88.7 %, respectively, while those in control group were 100.0 % and 90.5 %, respectively (P>0.05). The main adverse reactions were Grade Ⅲ-Ⅳ neutropenia and alopecia in TPF group. Conclusion Short-term effects of induction chemotherapy with one cycle of TPF regimen in the N advanced local NPC is satisfied, and the main toxicity is neutropenia.