TP F方案诱导化疗联合替吉奥同步放疗治疗局部晚期鼻咽癌的临床观察

摘要

目的：探讨TPF方案诱导化疗联合替吉奥（ S⁃1）同步调强适形放疗（ IMRT）治疗局部晚期鼻咽癌的临床疗效及安全性。方法采用诱导化疗联合S⁃1同步 IMRT治疗38例局部晚期鼻咽癌患者，诱导化疗采用 TPF方案：紫杉醇（PTX）135 mg／m2，静滴，d1；顺铂（DDP）80 mg／m2静滴，d1；氟尿嘧啶（5⁃FU）750 mg／（m2·d），持续静脉泵入，d1～d5（120 h）。21天为1个周期，共行2个周期。同步化疗采用替吉奥（ S⁃1）单药，40 mg／m2，口服，2次／日，d1～d14。21天为1个周期，共行2～3个周期。同步放疗PGTVnx（69．96～73．92）Gy／33 f，PGTVnd 69．96 Gy／33 f，PTV160．06 Gy／33 f，PTV250．96 Gy／28 f， PTVnd 50．96 Gy／28 f，1次／日，5次／周。结果38例患者均完成2个周期诱导化疗和2～3个周期同步放化疗。所有患者治疗结束评价即刻疗效，获CR 29例，PR 8例，SD 1例，有效率（ RR）为97．4％。治疗结束3个月评价近期疗效，获CR 33例，PR 5例，RR为100％。诱导化疗的主要毒副反应为恶心、白细胞减少、血红蛋白减少。同步放化疗的主要毒副反应为口腔黏膜炎、放射野内皮炎、吞咽痛。其中3级口腔黏膜炎、放射野内皮炎、吞咽痛的发生率分别为7．9％、2．6％、2．6％，均无4、5级毒副反应。结论 TPF方案诱导化疗同步替吉奥化疗联合IMRT治疗鼻咽癌，近期疗效好，且毒副反应较小，患者耐受性好。%Objective To evaluate the safety and clinical effects of TPF scheme induction chemotherapy with S⁃1 concurrent chemotherapy combined with intensity⁃modulated radiotherapy( IMRT) in the treatment of locally advanced nasopharyngeal carcinoma. Methods Induction chemotherapy with concurrent chemoradiotherapy combined with IMRT in the treatment of 38 patients with locally advanced nasopharyngeal carcinoma. The induction chemotherapy was used by the TPF scheme:paclitaxel 135 mg/m2 , intravenous in⁃fusion d1;DDP 80 mg/m2, intravenous infusion,d1;5⁃fluorouracil 750 mg/(m2·d), continuous venous pumping,d1⁃d5(120 hours). 21 days as a cycle for 2 cycles. The concurrent chemotherapy was used by 40 mg/m2 of S⁃1, taken orally, twice a day,d1⁃d14 . 2l days as a cycle for 2⁃3 cycles. The concurrent radiotherapy was PGTVnx(69. 96⁃73. 92) Gy/33 f, PGTVnd 69. 96 Gy/33 f, PTV1 60. 06 Gy/33 f, PTV2 50. 96 Gy/28 f, PTVnd 50. 96 Gy/28 f, once a day, 5 times a week. Results All of 38 patients completed the induc⁃tion chemotherapy for 2 cycles and concurrent chemoradiotherapy for 2⁃3 cycles. The immediate effects was evaluated after the treat⁃ment. There were 29 cases of CR, 8 PR, 1 SD with 97. 4% of the response rate( RR) . The short⁃term effecacy was evaluated in three months after the treatment. There were 33 cases of CR, 5 PR with RR of 100%. The main side effects of induction chemotherapy were nausea, leukocyte and hemoglobin decrease, those of concurrent chemoradiotherapy were oral mucositis, dermatitis in the radiation field and odynophagia. Among them, the grade 3 mucositis ( 7. 9%) , dermatitis in the radiation field ( 2. 6%) and odynophagia ( 2. 6%) were occurred, without grade 4⁃5 toxicity. Conclusion TPF scheme inducing chemotherapy with S⁃1 concurrent chemoradio⁃therapy combined with IMRT in the treatment of nasopharyngeal carcinoma, has a great short⁃term effects and less side effects, which is an effective, tolerable and safe comprehensive treatment scheme.