奈达铂联合氟尿嘧啶诱导化疗治疗局部晚期鼻咽癌的疗效及安全性分析

目的 探讨治疗局部晚期鼻咽癌时奈达铂联合氟尿嘧啶诱导化疗的近期疗效和不良反应,并对其安全性进行分析.方法 选自120例局部晚期鼻咽癌患者;以患者入院时间先后顺序进行随机分组,实验组60例、对照组60例.实验组:静脉滴注奈达铂(80 mg/m2),d1;持续微泵输入氟尿嘧啶(500 mg/m2/d),d1~d5;每21天为1个疗程,连用2个疗程.对照组:静脉滴注卡铂(300 mg/m2),d1;持续微泵输入氟尿嘧啶(500 mg/m2/d),d1~d5;每21天为1个疗程,连用2个疗程.两组诱导化疗2个周期完成后14 d开始序贯适型调强放疗.序贯适型调强放疗:直线加速器适型调强放疗,每次2.18 Gy,每周5次.序贯放疗结束后进行MRI检查.结果 2个周期诱导化疗后,实验组鼻咽部CR+PR 48例,总有效率为80.00%,淋巴结总有效率为73.34%,对照组鼻咽部CR+PR 46例,总有效率为76.67%,淋巴结总有效率为71.43%,两组治疗疗效比较无显著差异(P>0.05);诱导化疗序贯放疗后,实验组鼻咽部和淋巴结总有效率分别为96.67%和100.00%,对照组鼻咽部和淋巴结总有效率分别为96.67%和100.0%,两组间疗效对比无显著差异(P>0.05),但两组诱导化疗后,疗效均显著提高;诱导化疗序贯放疗后总疗效对比,实验组CR率为83.33%;对照组CR率为70.00%.两组近期总疗效比较无显著差异(P>0.05);实验组血小板减少发生率为16.67%,明显低于对照组46.67%,两组比较差异显著(P<0.05);特别在Ⅲ、Ⅳ度,实验组发生率(1.67%)显著低于对照组(16.67%),两组比较有明显差异(P<0.05).实验组恶心呕吐发生率(76.67%)与对照组(83.33%)比较差异不大,无显著差异性.结论 在治疗局部晚期鼻咽癌时奈达铂联合氟尿嘧啶具有疗效好,不良反应轻的特点,值得在鼻咽癌诱导化疗中推广应用.

Efficacy and Safety of Nedaplatin Combined with Fluorouracil Induction Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma

Objective To investigate the efficacy ,adverse reactions and safety of nedaplatin combined with fluorouracil chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma .Methods 120 cases of locally advanced nasopha-ryngeal carcinoma patients were randomly divided into 2 groups,each with 60 cases.The experimental group received intravenous infusion of nedaplatin (80 mg/m2 ),D1;micro pump continuous infusion fluorouracil (500 mg/m2/d),d1 ~d5;every 21 days was 1 course,for 2 courses.The control group received intravenous infusion of carboplatin (300 mg/m2),D1;micro pump contin-uous infusion fluorouracil (500 mg/m2/d),d1~d5;every 21 days was 1 course,for 2 courses.After 2 cycles of induction chemo-therapy was completed ,and the 14 d was started by sequential adaptive intensity modulated radiation therapy .Sequential adaptive intensity modulated radiation therapy:linear accelerator radiotherapy ,2.18Gy,5 times per week.MRI examination after sequential radiotherapy.Results 2 cycles of induction chemotherapy ,CR+PR of nasopharynx in the experimental group was 48 cases,the total efficiency was 80.00%,the total effective rate of lymph nodes was 73.34%,nasopharyngeal CR +PR in the control group was 46 cases,the total efficiency was 76.67%,the total efficiency of lymph nodes was 71.43%,there had no significant differ-ence between the 2 groups( P>0.05);sequential induction chemotherapy after radiotherapy ,nasopharynx lymph node and total effective rate in the experimental group were 96.67%and 100.00%,nasopharynx and lymph nodes and total effective rate in the control group were 96.67%and 100.00%,there was no significant difference between the 2 groups (P>0.05),but the compar-ative efficacy of the 2 groups after induction chemotherapy ,the curative effect significantly improved;the total effect induced by chemotherapy after radiotherapy , CR in the experimental group was 83 .33%;CR in the control group was 70 .00%.There had no significant difference between the 2 groups in the total efficacy (P>0.05);thrombocytopenia incidence rate in the experimental group was 16.67%,which was significantly lower than the control group ,46.67%,there was significant difference between the 2 groups (P<0.05);especially in Ⅲ,Ⅳ,incidence of the experimental group (1.67%) was significantly lower than the control group (16.67%),there was significant difference between the 2 groups (P<0.05).The incidence of nausea and vomiting in the experimental group (76.67%) compared with the control group (83.33%),the difference was not significant ,and there was no significant difference .Conclusion Nedaplatin combined with fluorouracil for locally advanced nasopharyngeal carcinoma has good effect ,less adverse reaction ,and it is worthy of popularization and application in induction chemotherapy for nasopharyngeal carcinoma.