TPF方案时辰诱导化疗联合同步放化疗治疗局部晚期鼻咽癌的近期疗效观察
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摘要
目的探讨TPF时辰诱导化疗联合同步放化疗治疗局部晚期鼻咽癌的近期疗效。方法将117例局部晚期鼻咽癌患者采用随机数字表法分为对照组(57例)和观察组(60例),对照组给予DTX 75 mg/m~2静滴1 h d1(DDP前使用);DDP 75 mg/m~2静滴d1;5-Fu 750 mg/(m~2·d)持续静滴d1～d5,21 d为一个周期,共2周期。观察组DTX 75 mg/m~2,静滴,d1。DDP 75 mg/m~2,分5 d完成静滴给药,每天10:00～22:00。5-Fu 750 mg/(m~2·d),d1～d5,持续静滴,每天22:00～10:00。21 d为一个周期,共2个周期。2组化疗后评价有效者行三维适形调强放疗,同期放疗DDP 80 mg/m~2,d1～d3,静滴,21 d为一个周期,共2周期。分别于治疗前后检测2组患者血清巨噬细胞炎性蛋白-3α(MIP-3α)与半胱氨酸蛋白酶抑制剂A(cystatin A)表达水平并进行临床疗效评定。结果观察组患者鼻咽部肿瘤控制和颈部淋巴结控制有效率为94.74%,92.98%,对照组为92.72%,90.90%,差异无统计学意义(P> 0.05);2组患者血清MIP-3α和cystatin A表达水平均显著低于同组治疗前(P<0.05)。观察组生存质量改善情况显著高于对照组,且观察组不良发生率低于对照组(P<0.05)。结论 TPF方案时辰诱导化疗联合同步放化疗治疗局部晚期鼻咽癌患者近期疗效好,且毒副反应较小,患者耐受性好。
Objective To investigate the clinical efficacy and safety of TPF chrono-chemotherapy with concurrent chemoradiation in the Treatment of locally advanced nasopharyngeal carcinoma. Methods 117 patients with locally advanced nasopharyngeal carcinoma were randomly divided into control group and observ-ation group. Control group was treated with DTX75 mg/m~2,infusion,d1;DDP 75 mg/m~2,infusion,d1;and 5-Fu 750 mg/(m~2·d),continuous infusion,d1～d5,for three courses.Observation group was treated with DTX,75 mg/m~2,i.v. infusion,d1;DDP,75 mg/m~2,bolus infusion from 10:00 to 22:00,d1～d5;and 5-Fu 750 mg/(m~2·d)bolus infusion from 22:00 to 10:00,d1～d5,with 21 days each cycle. Patients who obtained therapecutic efficacy via induction chemotherapy were provided with intensity-modulated radiotherapy as a concurrent radiotherapy and chemoth-erapy(DDP 80 mg/m~2,infusion,d1～d3,with 21 days each cycle and a total of two courses). Acute and late toxicities were graded according to the Common Terminology Criteria for Adverse Events v3.0 scoring criteria.Tumor response was evaluated using2000 Response Evaluation Criteria in Solid Tumors criteria. Serum macrophage inflammatory protein-3α(MIP-3α)and cystatin A levels were compared in 2 groups before and after treatment 12 months were observed. Results After treatment,The efficient rate of nasopharyngeal carcinoma was 94.74% and of cervical lymph node was 92.98% in observation group. By contrast,the efficient rate of nasopharyngeal carcinoma was92.72 %,and of cervical lymph node 90.91% in control group respectively. Results showed no significant difference in the complete response efficient rate of both nasopharyngeal carcinoma and cervical lymph node with two groups(P>0.05).The serum levels of MIP-3α and cystatin A in two groups were significantly lower than those before(P<0.05).The improvement of quality of life in the observation group was better than that in the control group(P<0.05).There was statistical significance in the incidence of ADR between 2 groups(P<0.05). The vomit rate was 29.82 % in observation group,which was less than the data was 50.91% in control group(P<0.05).Conclusions TPF chrono-chemotherapy with concurrent chemoradiation in the treatment of locally advanced nasopharyngeal carcinoma has a great short-term effects and less side effects,which is an effective,tolerable and safe comprehensive treatment scheme.
Objective To investigate the clinical efficacy and safety of TPF chrono-chemotherapy with concurrent chemoradiation in the Treatment of locally advanced nasopharyngeal carcinoma. Methods 117 patients with locally advanced nasopharyngeal carcinoma were randomly divided into control group and observ-ation group. Control group was treated with DTX75 mg/m~2,infusion,d1;DDP 75 mg/m~2,infusion,d1;and 5-Fu 750 mg/(m~2·d),continuous infusion,d1～d5,for three courses.Observation group was treated with DTX,75 mg/m~2,i.v. infusion,d1;DDP,75 mg/m~2,bolus infusion from 10:00 to 22:00,d1～d5;and 5-Fu 750 mg/(m~2·d)bolus infusion from 22:00 to 10:00,d1～d5,with 21 days each cycle. Patients who obtained therapecutic efficacy via induction chemotherapy were provided with intensity-modulated radiotherapy as a concurrent radiotherapy and chemoth-erapy(DDP 80 mg/m~2,infusion,d1～d3,with 21 days each cycle and a total of two courses). Acute and late toxicities were graded according to the Common Terminology Criteria for Adverse Events v3.0 scoring criteria.Tumor response was evaluated using2000 Response Evaluation Criteria in Solid Tumors criteria. Serum macrophage inflammatory protein-3α(MIP-3α)and cystatin A levels were compared in 2 groups before and after treatment 12 months were observed. Results After treatment,The efficient rate of nasopharyngeal carcinoma was 94.74% and of cervical lymph node was 92.98% in observation group. By contrast,the efficient rate of nasopharyngeal carcinoma was92.72 %,and of cervical lymph node 90.91% in control group respectively. Results showed no significant difference in the complete response efficient rate of both nasopharyngeal carcinoma and cervical lymph node with two groups(P>0.05).The serum levels of MIP-3α and cystatin A in two groups were significantly lower than those before(P<0.05).The improvement of quality of life in the observation group was better than that in the control group(P<0.05).There was statistical significance in the incidence of ADR between 2 groups(P<0.05). The vomit rate was 29.82 % in observation group,which was less than the data was 50.91% in control group(P<0.05).Conclusions TPF chrono-chemotherapy with concurrent chemoradiation in the treatment of locally advanced nasopharyngeal carcinoma has a great short-term effects and less side effects,which is an effective,tolerable and safe comprehensive treatment scheme.
引文
[1]杨宏山,瞿广桥.奈达铂联合氟尿嘧啶诱导化疗加同步放化疗治疗局部晚期鼻咽癌近期疗效[J].实用医药杂志,2015,32(5):409-411.
[2]陈建武,张幸平,刘德鑫,等.动脉灌注诱导化疗联合同期放化疗治疗局部晚期鼻咽癌的疗效[J].中国老年学杂志,2014,34(23):6598-6600.
[3] BAE W K,HWANG J E,SHIM H J,et al. Phase II study of docetaxel,cisplatin, and 5-FU induction chemotherapy followed by chemoradiotherapy in locoregionally advanced nasopharyngeal cancer[J].Cancer Chemother Pharm-acol,2010,65(3):589-595.
[4] VAN HERPEN C M,MAUER M E,MESIA R,et al. Short-term health related quality of life and symptom control with docetaxel,cisplatin,5-fluorouracil and cisplatin(TPF),5-fluorouracil(PF)for induction in unresectablen locoer-gionally advanced head and neck cancer patients(EORTC 24971/TAX 323)[J]. Br J Cancer,2010,103(8):1173-1181.
[5] DU C,YING H,ZHOU J,et al. Experience with combination of docetaxel, cisplatin plus 5-fluorouracil chemother-apy, and intensitymodulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma[J]. Int J Clin Oncol,2013,18(3):464-471.
[6]李卓玲,金风,吴伟莉,等.诱导化疗加同步放化疗治疗鼻咽癌的临床观察[J].现代肿瘤临床,2015,23(6):774-778.
[7]毛振华,金风,吴伟莉,等.时辰化疗治疗初治远处转移鼻咽癌的临床研究[J].中国肿瘤临床,2015,42(14):709-715.
[8]李军,汤敏中,陆爱英,等.鼻咽癌患者血清MIP-3α与cystatin A表达及其临床意义[J].中国癌症杂志,2013,23(10):845-851.
[9]谢源福,林坤花,卓延红,等.诱导化疗加同步放化疗治疗局部晚期鼻咽癌的疗效观察[J].中国肿瘤临床与康复,2014,21(2):198-201.
[10] LEE A W,TUNG S Y,CHUA D T,et al. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma[J].J Natl Cancer Inst,2010,102(15):1188-1198.
[11]殷蔚伯,余子豪,徐国镇,等.肿瘤放射治疗学[M].北京:中国协和医科大学出版社,2008:451-478.
[12]吕星,郭翔,洪明晃,等.多西紫杉醇联合卡铂与氟尿嘧啶联合卡铂治疗局部晚期鼻咽癌近期疗效的比较[J].癌症,2010,29(2):148-152.
[13]熊娟,李光明.生物钟基因与肿瘤时辰治疗的研究进展[J].现代肿瘤医学,2013,21(11):2622-2625.
[14]王培培,李明春.昼夜节律与肿瘤时辰化疗作用机制的研究进展[J].中国医院药学杂志,2014,34(6):499-503.
[15] ZENG Z L,SUN J,GUO L, et al. Circadian rhythm in dihydropyrimidine dehydrogenase activity and reduced glutathione content in peripheral blood of nasopharyngeal carcinoma patients[J].Chronobiol Int,2005,22(4):741-754.
[16] ZENG Z L,SUN J,GUO L,et al. Circadian rhythm in dihydropyrimi.dine dehydrogenase activity and reduced glutathione content inperipheral blood of nasopharyngeal carcinoma patients[J]. Chro.nobiol Int,2005,22(4):741-754.
[17] LAZENNEC G,RICHMOND A. Chemokines and chemokine receptors:new insights into cancer-related inflamm-ation[J].Trends Mol Med,2010,16(3):133-144.
[18] CAMPBELLA S,ALBO D,KIMSEY T F,et al. Macrophage inflammatory protein-3alpha promotes pancreatic cancer cell invasion[J]. J Surg Res,2005,123(1):96-101.
[19] MAGISTER S,KOS J. Cystatins in immune system[J]. J Cancer,2013,4(1):45-56.
[2]陈建武,张幸平,刘德鑫,等.动脉灌注诱导化疗联合同期放化疗治疗局部晚期鼻咽癌的疗效[J].中国老年学杂志,2014,34(23):6598-6600.
[3] BAE W K,HWANG J E,SHIM H J,et al. Phase II study of docetaxel,cisplatin, and 5-FU induction chemotherapy followed by chemoradiotherapy in locoregionally advanced nasopharyngeal cancer[J].Cancer Chemother Pharm-acol,2010,65(3):589-595.
[4] VAN HERPEN C M,MAUER M E,MESIA R,et al. Short-term health related quality of life and symptom control with docetaxel,cisplatin,5-fluorouracil and cisplatin(TPF),5-fluorouracil(PF)for induction in unresectablen locoer-gionally advanced head and neck cancer patients(EORTC 24971/TAX 323)[J]. Br J Cancer,2010,103(8):1173-1181.
[5] DU C,YING H,ZHOU J,et al. Experience with combination of docetaxel, cisplatin plus 5-fluorouracil chemother-apy, and intensitymodulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma[J]. Int J Clin Oncol,2013,18(3):464-471.
[6]李卓玲,金风,吴伟莉,等.诱导化疗加同步放化疗治疗鼻咽癌的临床观察[J].现代肿瘤临床,2015,23(6):774-778.
[7]毛振华,金风,吴伟莉,等.时辰化疗治疗初治远处转移鼻咽癌的临床研究[J].中国肿瘤临床,2015,42(14):709-715.
[8]李军,汤敏中,陆爱英,等.鼻咽癌患者血清MIP-3α与cystatin A表达及其临床意义[J].中国癌症杂志,2013,23(10):845-851.
[9]谢源福,林坤花,卓延红,等.诱导化疗加同步放化疗治疗局部晚期鼻咽癌的疗效观察[J].中国肿瘤临床与康复,2014,21(2):198-201.
[10] LEE A W,TUNG S Y,CHUA D T,et al. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma[J].J Natl Cancer Inst,2010,102(15):1188-1198.
[11]殷蔚伯,余子豪,徐国镇,等.肿瘤放射治疗学[M].北京:中国协和医科大学出版社,2008:451-478.
[12]吕星,郭翔,洪明晃,等.多西紫杉醇联合卡铂与氟尿嘧啶联合卡铂治疗局部晚期鼻咽癌近期疗效的比较[J].癌症,2010,29(2):148-152.
[13]熊娟,李光明.生物钟基因与肿瘤时辰治疗的研究进展[J].现代肿瘤医学,2013,21(11):2622-2625.
[14]王培培,李明春.昼夜节律与肿瘤时辰化疗作用机制的研究进展[J].中国医院药学杂志,2014,34(6):499-503.
[15] ZENG Z L,SUN J,GUO L, et al. Circadian rhythm in dihydropyrimidine dehydrogenase activity and reduced glutathione content in peripheral blood of nasopharyngeal carcinoma patients[J].Chronobiol Int,2005,22(4):741-754.
[16] ZENG Z L,SUN J,GUO L,et al. Circadian rhythm in dihydropyrimi.dine dehydrogenase activity and reduced glutathione content inperipheral blood of nasopharyngeal carcinoma patients[J]. Chro.nobiol Int,2005,22(4):741-754.
[17] LAZENNEC G,RICHMOND A. Chemokines and chemokine receptors:new insights into cancer-related inflamm-ation[J].Trends Mol Med,2010,16(3):133-144.
[18] CAMPBELLA S,ALBO D,KIMSEY T F,et al. Macrophage inflammatory protein-3alpha promotes pancreatic cancer cell invasion[J]. J Surg Res,2005,123(1):96-101.
[19] MAGISTER S,KOS J. Cystatins in immune system[J]. J Cancer,2013,4(1):45-56.