奈达铂或顺铂联合紫杉醇同步放化疗局部晚期鼻咽癌的疗效比较

摘要

Objective To explore the efficacy and toxicities of nedaplatin and paclitaxel combined with radiotherapy in the treatment of patients with locally advanced nasopharyngeal carcinoma. Methods Patients in the experimental group ( TN group, 30 patients ) were treated with intravenous infusion of paclitaxel 135 mg/m2 and nedaplatin 100 mg/m2 for 2 cycles every 3 weeks, followed by 2 cycles of the same chemotherapy and concurrent radiotherapy. Treatment for patients in the control group ( TP group,30 patients ) was similar to that in the TN group,except that nedaplatin was replaced by cisplatin ( 30 mg/m2 ,dl ～ 3 ). Results After 2 cycles of induction chemotherapy,the response rates of the primary tumor in the TN and TP groups were 78.6％ and 73.3％ ( P ＞ 0.05 ), and the response rates of the cervical lymph node were 82.1％ and 80％ ( P ＞ 0.05 ). Three months after the chemo- radiotherapy, the response rates in the two groups were 100％. The incidence of neutropenia in the TN group ( 50％, 14/28 ) was significantly less than that in the TP group ( 86.7％, 13/15 ,P = 0.02 ); the incidence of anemia in the TN and TP groups was 17.9％ ( 5/28 ) and 53.3％ ( 8/15 ), with significant difference ( P = 0.02 ). Thrombocytopenia and damage to liver or kidney were not significantly different in the two groups. The incidence of nausea and vomiting was significantly lower in the TN group than that in the control group. Conclusion Nedaplatin and paclitaxel combined with radiotherapy is effective and tolerable in the treatment of patients with locally advanced nasopharyngeal carcinoma.%目的 探讨奈达铂替代顺铂与紫杉醇联合同步放化疗局部晚期鼻咽癌的疗效及患者耐受性.方法 实验组(TN组)30例,采用紫杉醇135 mg/m2 静脉滴注 d1+奈达铂100 mg/m2 静脉滴注第1天诱导化疗,每3周为1个化疗周期,共2个疗程,以后行同样方案同期放化疗,仍然每3周为1个化疗周期,共2个疗程.对照组(TP组)30例,采用顺铂(30 mg/m2静脉滴注第1～3天) 代替奈达铂,其余治疗方法与实验组相同.结果 诱导化疗2个周期后评价疗效:鼻咽部原发灶有效率实验组和对照组分别是78.6%和73.3%,P＞0.05,差异无统计学意义;颈部淋巴结转移灶有效率实验组和对照组分别是82.1%和80.0%,P＞0.05,差异无统计学意义.治疗后3个月鼻咽原发灶和颈部淋巴结转移灶的有效率均是100%.不良反应显示实验组和对照组白细胞减少的发生率分别为 50.0% (14/28) 和86.7%(13/15)(P=0.02),差异有统计学意义;贫血发生率分别为17.9%(5/28)和53.3%(8/15)(P=0.02),差异有统计学意义;血小板下降的发生率分别为42.9%(12/28)和20.0%(3/15)(P= 0.09),差异无统计学意义. 肝肾功能损害差异无统计学意义;恶心呕吐发生率实验组明显低于对照组,差异有统计学意义;体重下降(>10%)的发生率实验组明显低于对照组,差异有统计学意义.结论 奈达铂联合紫杉醇结合同步放疗治疗局部晚期鼻咽癌疗效确切,且患者耐受性良好.