80例Ⅲ、Ⅳ期鼻咽癌采用DFP与PFB方案同期化放疗的疗效比较

The Comparison of Efficacy between Concurrent DFP and PFB Chemotherapy in Combination with Radiotherapy for 80 Patients with Nasopharyngeal Carcinoma of Stage Ⅲ or Ⅳ

    摘要
  • 摘要: 目的:应用DFP方案(多西紫杉醇,5-氟脲嘧啶和顺铂)及PFB方案(5-氟脲嘧啶,顺铂和平阳霉素)与放疗同步治疗Ⅲ,Ⅳ期鼻咽癌,观察比较两组的局控率,生存率及不良反应。方法:对80例经过病理学证实且无远处转移的Ⅲ,Ⅳ期初治鼻咽癌患者给予同期化放疗,随机分为DFP组和PFB组,两组各40例。DFP组多西紫杉醇60mg·m2·d,静脉滴注,d1(或d1,d8),顺铂25mg·m2·d,静脉滴注,d2～5,5-氟脲嘧啶500mg·m2·d,静脉滴注,d2～5。PFB组顺铂25mg·m2·d,静脉滴注,d1～5,5-氟脲嘧啶500mg·m2·d,静脉滴注,d1～5,平阳霉素16mg,深部肌注,d1,3,5。两组均为21天一个周期,共2个周期。放疗采用60COγ线照射,常规分割,与化疗同期进行。肿瘤原发灶DT65～70Gy/6.5～7.5周,颈部转移淋巴结区DT55～66Gy/6～7周。颈部,锁骨上窝预防照射区DT50Gy/5周。结果:DFP组总有效率(CR+PR)为95.0%,1年无复发生存率为85.0%,1年无转移生存率为90.0%;PFB组总有效率(CR+PR)为85.0%,1年无复发生存率为80.0%,1年无转移生存率为70.0%。两组间有效率、1年无复发生存率比较差异无显著性,1年无转移生存率比较差异有统计学意义(P<0.05)。最常见的不良反应为恶心,呕吐,DFP组主要不良反应是急性口腔粘膜炎和白细胞下降(Ⅲ+Ⅳ度分别为50.0%和40.0%),但在G-CSF的支持下均可耐受。结论:DFP组和PFB组相比,近期疗效和1年无复发生存率相似,1年无转移生存率DFP组优于PFB组,但Ⅲ～Ⅳ度不良反应较PFB组为重,应有切实的措施减轻不良反应。

     

    Abstract: Objective: To compare the rates of local control, survival and toxicity of concurrent DFP (DOC, DDP plus 5-FU) versus PFB (DDP, 5-FU plus BLM) chemotherapy in combination with radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Methods: A total of 80 patients with stage-Ⅲ or stage-Ⅳ nasopharyngeal carcinoma diagnosed pathologically, without distance metastasis, were randomly divided into two groups. The DFP chemotherapy regiment was administered as follows: docetaxel 60mg /m2/d, i.v. infusion on day 1 (or day 1, days 8), cisplatin 25 mg/m2/d, on day 2 to 5, 5-Fu 500 mg/m2/d, on day 2 to 5. The PFB chemotherapy regiment was as follows: cisplatin 25 mg /m2/d, on day 2 to 5, 5-Fu 500 mg/m2/d, on day 2 to 5, pinyangmycin 16 mg, i.m, on day 1, 3 and 5. Each chemotherapy regiment was administered for 2 cycles, with 21 days each cycle. Radiotherapy was used by cobalt-60, with simultaneous chemotherapy. The patients were treated by conventional fraction. The accumulated radiation dose was 65 to 70Gy/6.5 to 7.5 weeks for primary tumor, 55 to 66Gy/6 to 7 weeks for the involved area of the neck was and 50Gy/5 weeks for the uninvolved area. Results: The overall response rate (complete response and part response) was 95.0% and 85.0% in DPF group and PFB group, respectively. The 1-year free from local regional failure survival rate (FLF) was 85.0% and 80.0% and the 1-year free-distant metastasis survival rate (FDM) was 90.0% and 70.0%. The difference of overall response rate and the 1-year FLF between the two groups were not statistically significant. The difference of 1-year FDM was statistically significant (P<0.05). The adverse effects were nause and vomiting. The main toxicity were acute inflammation of oral mucosa and leucopenia (grade Ⅲ or Ⅳ was 50.0% or 40.0%) in the DPF group. The difference between the two groups was statistically significant. But these can be tolerable by using G-CSF. Conclusion: The short efficacy and the 1-year FLF between the DFP and the BFP group are clear. The 1-year FDM in the DFP group is better than the BFP group but the grade III or IV toxicity is higher, too. The measures should be taken to reduce the toxicity.

     

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