多西他赛联合顺铂、氟尿嘧啶方案诱导化疗局部晚期鼻咽癌近期临床观察

目的：评价多西他赛联合顺铂和氟尿嘧啶方案（DPF方案）诱导化疗局部晚期鼻咽癌的近期临床疗效和毒性反应。方法：对25例经病理学证实的Ⅲ、Ⅳa期初治鼻咽癌患者于第1天静脉滴注多西他赛75 mg·m-2和顺铂75 mg·m-2,氟尿嘧啶2.5 g·m-2持续静脉泵入120 h,每3周为1疗程,2疗程后行同期放化疗。同期化疗方案为顺铂40 mg·m-2每周一次。结果：25例患者中,诱导化疗后鼻咽原发灶CR 5例（20.0%）、PR 18例（72.0%）、SD2例（8.0%）,总有效率为92%;颈部转移灶CR 4例（16.0%）、PR 21例（84.0%）,总有效率为100%。放化疗后CR 24例（96%）、PR 1例（4%）。毒性反应主要为骨髓抑制、口腔粘膜和胃肠道反应,Ⅲ∽Ⅳ度粒细胞减少占56%,60%以上的患者出现了中度（Ⅱ、Ⅲ度）胃肠道反应,其它毒副反应少见。综合治疗完成后有1例患者出现颈部淋巴结残留,其余患者均达CR。结论：多西他赛、顺铂及5-氟尿嘧啶诱导化疗较PF方案提高了局部晚期鼻咽癌的近期疗效,而且不良反应可以接受。其近期有效率的提高是否能转化为远期疗效值得进一步研究。

Observaion on Short-term Clinical Effect of Docetaxel Combined with Cisplatin and Fluorouracil for induction chemotherapy in patients with Locally Advanced Nasopharyngeal Carcinoma

Objective： To evaluate the clinical effect and toxic reaction of docetaxel combined with cisplatin and fluorouracil for induction chemotherapy in the treatment of patients with locally advanced nasopharyngeal carcinoma. Methods：Twenty-five patients with locally advanced nasopharyngeal carcinoma diagnosed pathologically were injected docetaxel（ 75mg·m- 2） and cisplatin（ 75 mg·m- 2） on the first day they were enrolled in by intravenous dripping; fluorouracil（ 2. 5 g·m- 2） in 120 hours by continuous intravenous pumping for 2 courses with a course of 3 weeks. Concurrent chemotherapy was received. Cisplatin（ 40 mg·m- 2） was injected once a week in the concurrent chemotherapy regimens. Results： Of all the 25 patients,completed response（ CR） of nasopharyngeal primary tumor was 5 cases（ 20. 0%）,partial responses（ PR） was 18 cases（ 72. 0%）,stable disease（ SD） was 2 cases（ 8. 0%）,and overall response rate was96. 0%; completed response（ CR） of neck metastasis lymph node was 4 cases（ 16. 0%）,partial responses（ PR） was 21cases（ 84. 0%）,and overall response rate was 100. 0%. The main toxicity was myelosuppression and gastrointestinal reactions,Ⅲ ∽ Ⅳ leucopenia occurred in 56. 0% of all cases,and Ⅱ ∽ Ⅲ gastrointestinal reactions occurred more than60%,It was rare to have other side effects. After Comprehensive treatment,all the cases got to CR except one case with neck lymph node residues. Conclutions： Compared with PF regimen,The docetaxel combined with cisplatin and fluorouracil regimen increases short-term clinical effect of locally advanced nasopharyngeal carcinoma; the toxicity and side effects are well-tolerated. It is worthy of further clinical studies on whether its increased short-term effects could turn into longterm effects.