紫杉醇联合奈达铂诱导化疗后同步放化疗治疗局部晚期鼻咽癌52例
|
摘要
目的探讨紫杉醇联合奈达铂(TP)诱导化疗序贯同步放化疗与单纯同步放化疗治疗局部晚期鼻咽癌的疗效和不良反应。方法选取安徽医科大学附属安庆医院从2012年1月至2014年12月首诊为局部晚期鼻咽癌的病人102例,按随机数字表法分组,对照组50例:对病人行单纯同步放化疗;试验组52例:对病人行TP诱导化疗序贯同步放化疗,比较两组的近、远期疗效及不良反应。结果试验组完全缓解41例,部分缓解9例,总有效率为96.2%(完全缓解:78.9%;部分缓解:17.3%),对照组完全缓解26例,部分缓解18例,总有效率为88.0%(完全缓解:52.0%;部分缓解:36.0%),两组间疗效比较采用秩和检验,差异有统计学意义(Uc=8.228,P=0.004)。试验组治疗后出现白细胞减少、贫血、血小板减少、肝肾功能损害、口腔黏膜炎、皮炎、恶心呕吐反应发生率与对照组均差异无统计学意义(P>0.05)。试验组随访1、2、3年总生存率分别为100.0%、93.7%、84.7%,无疾病进展生存率分别为98.0%、91.6%、80.4%,对照组随访1、2、3年总生存率分别为94.0%、85.7%、70.1%,无疾病进展生存率分别为88.0%、75.1%、67.4%,试验组1、2、3年总生存率及无疾病进展生存率显著高于对照组,差异有统计学意义(P<0.05)。结论相比单纯同步放化疗,紫杉醇联合奈达铂新辅助化疗后序贯同步放化疗治疗局部晚期鼻咽癌的近、远期疗效更佳,且不良反应可耐受。
Objective To investigate the efficacy and adverse reactions of paclitaxel and nedaplatin(TP) neoadjuvant chemotherapy followed by concurrent chemoradiation and simple concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma.Methods A total of 102 patients initially diagnosed as locally advanced nasopharyngeal carcinoma in Anqing Hospital Affiliated to Anhui Medical University from January 2012 to December 2014 were enrolled in the study and assigned into two groups according to random number table.The control group(n=50) was treated with simple concurrent chemoradiotherapy,while the experimental group(n=52)was treated with TP-induced chemotherapy followed by concurrent chemoradiotherapy.The short-term and long-term effects and adverse reactions of the two groups were compared.Results In the experimental group,41 patients had complete remission and 9 patients had partial remission.The total effective rate was 96.2%(total remission:78.9%;partial relief:17.3%).In the control group,26 patients had complete remission and 18 patients had partial remission.The total effective rate was 88.0%(total remission:52.0%;partial relief:36.0%).The rank-sum test results showed that the difference in efficacy between the two groups was statistically significant(Uc=8.228,P=0.004).In terms of side effects,there was no significant difference in the incidence rates of leukopenia,anemia,thrombocytopenia,hepatic and renal insufficiency,mucositis,dermatitis and vomiting(P>0.05).The 1,2,3-year total survival rates of the experimental group were 100.0%,93.7% and 84.7%,respectively.The 1,2,3-year total survival rates of the control group were 94.0%,85.7% and 70.1%,respectively.The 1,2,3-year progression-free survival rates of the experimental group were 98.0%,91.6% and 80.4%,respectively.The 1,2,3-year progression-free survival rates of the control group were 88.0%,75.1% and 67.4%,respectively.The 1,2,3-year total survival rates and progression-free survival rates in the experimental group were significantly higher than the control group;the differences between the 2 groups were significant(P<0.05).Conclusion Sequential concurrent chemoradiotherapy with paclitaxel and nedaplatin in the treatment of locally advanced nasopharyngeal carcinoma has better short-term and long-term efficacy and tolerable adverse side effects than simple concurrent chemoradiotherapy.
Objective To investigate the efficacy and adverse reactions of paclitaxel and nedaplatin(TP) neoadjuvant chemotherapy followed by concurrent chemoradiation and simple concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma.Methods A total of 102 patients initially diagnosed as locally advanced nasopharyngeal carcinoma in Anqing Hospital Affiliated to Anhui Medical University from January 2012 to December 2014 were enrolled in the study and assigned into two groups according to random number table.The control group(n=50) was treated with simple concurrent chemoradiotherapy,while the experimental group(n=52)was treated with TP-induced chemotherapy followed by concurrent chemoradiotherapy.The short-term and long-term effects and adverse reactions of the two groups were compared.Results In the experimental group,41 patients had complete remission and 9 patients had partial remission.The total effective rate was 96.2%(total remission:78.9%;partial relief:17.3%).In the control group,26 patients had complete remission and 18 patients had partial remission.The total effective rate was 88.0%(total remission:52.0%;partial relief:36.0%).The rank-sum test results showed that the difference in efficacy between the two groups was statistically significant(Uc=8.228,P=0.004).In terms of side effects,there was no significant difference in the incidence rates of leukopenia,anemia,thrombocytopenia,hepatic and renal insufficiency,mucositis,dermatitis and vomiting(P>0.05).The 1,2,3-year total survival rates of the experimental group were 100.0%,93.7% and 84.7%,respectively.The 1,2,3-year total survival rates of the control group were 94.0%,85.7% and 70.1%,respectively.The 1,2,3-year progression-free survival rates of the experimental group were 98.0%,91.6% and 80.4%,respectively.The 1,2,3-year progression-free survival rates of the control group were 88.0%,75.1% and 67.4%,respectively.The 1,2,3-year total survival rates and progression-free survival rates in the experimental group were significantly higher than the control group;the differences between the 2 groups were significant(P<0.05).Conclusion Sequential concurrent chemoradiotherapy with paclitaxel and nedaplatin in the treatment of locally advanced nasopharyngeal carcinoma has better short-term and long-term efficacy and tolerable adverse side effects than simple concurrent chemoradiotherapy.
引文
[1] TORRE LA,BRAY F,SIEGEL RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
[2] LEE AW,MA BB,NG WT,et al.Management of nasopharyngeal carcinoma:currentpractice and future perspective[J].J Clin Oncol,2015,33(29):3356-3364.
[3] NG WT,LEE MC,CHANG AT,et al.The impact of dosimetricinadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT[J].Oral Oncol,2014,50(5):506-512.
[4] ZHANG LF,LI YH,XIE SH,et al.Incidence trend of nasopharyngeal carcinoma from 1987 to 2011 in Sihui county,Guangdong province,south China:an age-period-cohort analysis[J].Chin J Cancer,2015,34(8):350-357.
[5] BAUJAT B,AUDRY H,BOURHIS J, et al.Chemotherapy as an adjunct to radiotherapy in locally advanced nasopharyngeal carcinoma[J].Cochrane Database Syst Rev,2006(4):CD004329.DOI:10.1002/14651858.CD004329.pub2.
[6] RIBASSIN-MAJED L,MARGUET S,LEE AW,et al.What is the best treatment of locally advanced nasopharyngeal carcinoma? An individual patient data meta-analysis[J].J Clin Oncol,2017,35(5):498-505.
[7] SUN Y,LI WF,CHEN NY,et al.Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:a phase 3,multicentre,randomized controlled trial[J].Lancet Oncol,2016,17(11):1509-1520.
[8] CASANOVA M,?ZYAR E,PATTE C,et al.International randomized phase 2 study on the addition of docetaxel to the combination of cisplatin and 5-fluorouracil in the induction treatment for nasopharyngeal carcinoma[J].Pharmacol,2016,77(2):289-298.
[9] LEE AW,LAU WH,TUNG SY,et al.Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally advanced nasopharyngeal carcinoma:NPC-9901 trial by the Hong Kong Nasopharyngeal Cancer Study Group[J].J Clin Oncol,2005,23(28):6966-6975.
[10] 韩淑红,于兰,张佩娟,等.局部晚期鼻咽癌诱导化疗后调强放疗同期化疗疗效评价[J].中华放射肿瘤学杂志,2013,22(1):47-51.
[11] CHEN L,HU CS,CHEN XZ,et al.Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma:a phase 3 multicentre randomized controlled trial[J].Lancet Oncol,2012,13(2):163-171.
[12] CHAN AT,MA BB,LO YM,et al.Phase II study of neoadjuvant carboplatin and paclitaxel followed by radiotherapy and concurrent cisplatin in patients with locoregionally advanced nasopharyngeal carcinoma:therapeutic monitoring with plasma Epstein-Barr virus DNA[J].J Clin Oncol,2004,22(15):3053-3060.
[13] FOUNTZILAS G,CIULEANU E,BOBOS M,et al.Inductio chemotherapy followed by concomitant radiotherapy and weekly cisplatin versus the same concomitant chemoradiotherapy in patients with nasopharyngeal carcinoma:a randomized phase II study conducted by the Hellenic Cooperative Oncology Group (HeCOG) with biomarker evaluation[J].Ann Oncol,2012,23(2):427-435.
[14] TAN T,LIM WT,FONG KW,et al.Concurrent chemo-radiation with or without induction gemcitabine,Carboplatin,and Paclitaxel:a randomized,phase 2/3 trail in locally advanced nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2015,91(5):952-960.
[15] HUI EP,MA BB,LEUNG SF,et al.Randomized phase II trial ofconcurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma[J].J Clin Oncol,2009,27(2):242-249.
[16] ZHENG J,WANG G,YANG GY,et al.Induction chemotherapy with nedaplatin with 5-FU followed by intensity-modulated radiotherapy concurrent with chemotherapy for locoregionally advancednasopharyngeal carcinoma[J].Jpn J Clin Oncol,2010,40(5):425-431.
[17] LORCH JH,GOLOUBEVA O,HADDAD RI,et al.Induction chemotherapy with cisplatin and fluorouracil alone or incombination with docetaxel in locally advanced squamous-cell cancer of the head and neck:long-term results of the TAX 324 randomised phase 3 trial[J].Lancet Oncol,2011,12(2):153-159.
[18] DU J,HU C,ZHANG Y,et al.A retrospective study of paclitaxel combining nedaplatin chemotherapy for esophageal cancer[J].Anticancer Drugs,2015,26(1):101-105.
[19] XU J,CHENG K,GUO W,et al.Concurrent chemoradiotherapy with nedaplatin plus paclitaxel or fluorouracil for locoregionally advanced nasopharyngeal carcinoma:Survival and toxicity[J].Head Neck,2014,36(10):1474-1480.
[2] LEE AW,MA BB,NG WT,et al.Management of nasopharyngeal carcinoma:currentpractice and future perspective[J].J Clin Oncol,2015,33(29):3356-3364.
[3] NG WT,LEE MC,CHANG AT,et al.The impact of dosimetricinadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT[J].Oral Oncol,2014,50(5):506-512.
[4] ZHANG LF,LI YH,XIE SH,et al.Incidence trend of nasopharyngeal carcinoma from 1987 to 2011 in Sihui county,Guangdong province,south China:an age-period-cohort analysis[J].Chin J Cancer,2015,34(8):350-357.
[5] BAUJAT B,AUDRY H,BOURHIS J, et al.Chemotherapy as an adjunct to radiotherapy in locally advanced nasopharyngeal carcinoma[J].Cochrane Database Syst Rev,2006(4):CD004329.DOI:10.1002/14651858.CD004329.pub2.
[6] RIBASSIN-MAJED L,MARGUET S,LEE AW,et al.What is the best treatment of locally advanced nasopharyngeal carcinoma? An individual patient data meta-analysis[J].J Clin Oncol,2017,35(5):498-505.
[7] SUN Y,LI WF,CHEN NY,et al.Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:a phase 3,multicentre,randomized controlled trial[J].Lancet Oncol,2016,17(11):1509-1520.
[8] CASANOVA M,?ZYAR E,PATTE C,et al.International randomized phase 2 study on the addition of docetaxel to the combination of cisplatin and 5-fluorouracil in the induction treatment for nasopharyngeal carcinoma[J].Pharmacol,2016,77(2):289-298.
[9] LEE AW,LAU WH,TUNG SY,et al.Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally advanced nasopharyngeal carcinoma:NPC-9901 trial by the Hong Kong Nasopharyngeal Cancer Study Group[J].J Clin Oncol,2005,23(28):6966-6975.
[10] 韩淑红,于兰,张佩娟,等.局部晚期鼻咽癌诱导化疗后调强放疗同期化疗疗效评价[J].中华放射肿瘤学杂志,2013,22(1):47-51.
[11] CHEN L,HU CS,CHEN XZ,et al.Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma:a phase 3 multicentre randomized controlled trial[J].Lancet Oncol,2012,13(2):163-171.
[12] CHAN AT,MA BB,LO YM,et al.Phase II study of neoadjuvant carboplatin and paclitaxel followed by radiotherapy and concurrent cisplatin in patients with locoregionally advanced nasopharyngeal carcinoma:therapeutic monitoring with plasma Epstein-Barr virus DNA[J].J Clin Oncol,2004,22(15):3053-3060.
[13] FOUNTZILAS G,CIULEANU E,BOBOS M,et al.Inductio chemotherapy followed by concomitant radiotherapy and weekly cisplatin versus the same concomitant chemoradiotherapy in patients with nasopharyngeal carcinoma:a randomized phase II study conducted by the Hellenic Cooperative Oncology Group (HeCOG) with biomarker evaluation[J].Ann Oncol,2012,23(2):427-435.
[14] TAN T,LIM WT,FONG KW,et al.Concurrent chemo-radiation with or without induction gemcitabine,Carboplatin,and Paclitaxel:a randomized,phase 2/3 trail in locally advanced nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2015,91(5):952-960.
[15] HUI EP,MA BB,LEUNG SF,et al.Randomized phase II trial ofconcurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma[J].J Clin Oncol,2009,27(2):242-249.
[16] ZHENG J,WANG G,YANG GY,et al.Induction chemotherapy with nedaplatin with 5-FU followed by intensity-modulated radiotherapy concurrent with chemotherapy for locoregionally advancednasopharyngeal carcinoma[J].Jpn J Clin Oncol,2010,40(5):425-431.
[17] LORCH JH,GOLOUBEVA O,HADDAD RI,et al.Induction chemotherapy with cisplatin and fluorouracil alone or incombination with docetaxel in locally advanced squamous-cell cancer of the head and neck:long-term results of the TAX 324 randomised phase 3 trial[J].Lancet Oncol,2011,12(2):153-159.
[18] DU J,HU C,ZHANG Y,et al.A retrospective study of paclitaxel combining nedaplatin chemotherapy for esophageal cancer[J].Anticancer Drugs,2015,26(1):101-105.
[19] XU J,CHENG K,GUO W,et al.Concurrent chemoradiotherapy with nedaplatin plus paclitaxel or fluorouracil for locoregionally advanced nasopharyngeal carcinoma:Survival and toxicity[J].Head Neck,2014,36(10):1474-1480.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |