调强放疗联合TP方案同期化疗治疗局部晚期鼻咽癌的初步研究

 目的　分析调强放疗（IMRT）联合TP方案多西紫杉醇（DOC）+顺铂（DDP）] 同期治疗鼻咽癌的近期疗效及患者不良反应，初步探讨该方案的可行性与有效性。方法　回顾性分析32例初诊Ⅲ～ⅣB期鼻咽癌患者临床资料，IMRT处方剂量：鼻咽肿瘤区计划靶区（PTVnx）总剂量7000 cGy，分31～32次；转移淋巴结计划靶区（PTVnd）总剂量6600 Gy，分31～32次；高危临床肿瘤区的计划靶区（PTV1）总剂量6000 cGy；PTVnx分次剂量220～228 cGy，31～32次。同期予2个疗程TP方案化疗，DOC 75 mg／m2 第1天静脉滴注，DDP 75 mg／m2 第1天静脉滴注（或者DDP 25 mg／m2 第1天至第3天静脉滴注），2个疗程化疗开始的时间间隔为21～28 d。结果　全组32例患者均完成全量IMRT放疗及2个疗程TP方案化疗。无治疗相关死亡。主要不良反应为血液毒性及口腔黏膜反应，Ⅲ～Ⅳ度白细胞减少占46.9 %（15／32），Ⅲ～Ⅳ度中性粒细胞减少占59.4 %（19／32），Ⅲ度急性黏膜反应占40.6 %（13／32）。本组病例的完全缓解（CR）率为96.9 %（31／32）。治疗过程中有29例（90.6 %）患者使用粒细胞集落刺激因子（G-CSF）。中位随访13个月，全组患者1年总生存（OS）率、无局部复发生存（LRFS）率、无区域复发生存（RRFS）率及无远处转移生存（DMFS）率分别为100.0 %（32／32）、96.9 %（31／32）、96.9 %（31／32）、96.9 %（31／32）。结论　IMRT联合同期TP方案治疗局部晚期鼻咽癌近期疗效好，CR率高，主要不良反应为白细胞及中性粒细胞减少，在G-CSF支持下患者能耐受。该方案的远期疗效值得进一步探讨。

Preliminary research of docetaxel plus cisplatin regimen with concurrent intensity-modulated radiation therapy in treating locally advanced nasopharyngeal carcinoma

Objective To assess the feasibility and efficacy of a docetaxel plus cisplatin regimen for patients of locally advanced nasopharyngeal carcinoma （NPC） treated concurrently with definitive IMRT in a short-term observation. Methods Radiation consisted of 7000 cGy given to the planning target volume （PTV） of primary tumor, 6600 cGy given to the PTV of metastatic lymph nodes and 6000 cGy to the PTV of subclinical disease in 220-228 cGy/fraction were delivered over 31-32 treatment days. Thirty-two patients with newly diagnosed NPC received definitive intensity-modulated radiation therapy （IMRT） concurrent with doeetaxel 75 mg/m2 on day 1 and DDP 75 mg/m2 on day 1 （or DDP 25 mg/m2 on day 1-day 3）, repeating every 21 to 28 days for 2 cycles. Results All patients received the full dose of radiotherapy and completed 2 cycles of chemotherapy with a median follow-up of 13 months （2-28 months）. No treatment-related death was observed. Major toxicities included hematologic ＇toxicity and mucositis. The incidence rates of grade 3-4 leucopenia, grade 3-4 neutropenia and grade 3 acute mucositis were 46.9 % （15/32）, 59.4 % （19/32） and 40.6 % （13/32） respectively. The complete remission （CR） rate was 96.9 % （31/32）. During treatment, 90.6 % （29/32） patients acquired granulocyte colony stimulating factor （G-CSF） for leucopenia. The 1-year overall survival, local recurrence-free survival, regional recurrence-free survival and distant metastasis-free survival were 100 % （31/32）, 96.9 % （31/32）, 96.9 % （31/32）, 96.9 % （31/32）, respectively, for the whole cohort. Conclusions 2 cycles of the docetaxel plus cisplatin regimen with concurrent IMRT are demonstrated being feasible and effective in treating locally advanced NPC with promising resuhs. The major toxicities are leueopenia and neutropenia, but they are tolerable with the use of G-CSF. Further investigation of long-term efficacy of the regimen is required.