不同化疗方案结合常规放疗治疗鼻咽癌临床病例回顾性分析

发布时间：2019-06-13 22:24

【摘要】：背景鼻咽癌(nasopharyngeal carcinoma,NPC)为发生于鼻咽部上皮及粘膜腺体的恶性肿瘤,在流行病学、组织病理学和解剖学方面有其独特的表现。主要好发于我国南方、东南亚、中东和北非等地。放疗是其最主要的治疗方法。在早期予以单纯放疗即可获得较为满意的疗效,5年生存率可达80%以上,但对无远处转移的局部晚期鼻咽癌而言,其疗效却不甚理想,出现远处转移者预后最差。近年来随着调强放疗及靶向治疗药物逐渐应用于临床,鼻咽部及颈部的局部控制率已有大幅度提高,患者放疗后的生活质量也有了明显的改善。虽然局部晚期鼻咽癌的局部控制率和总生存率也有所提高,但5年生存率仍然较差,局部复发和远处转移是主要的失败模式。目前,同期化放疗在局部晚期鼻咽癌治疗中已得到肯定,而诱导化疗和辅助化疗的作用仍存在较多争议。如何减少远处转移、提高总生存率?如何优化放化疗结合模式,利用化疗新药来提高治疗能效呢? 目的观察奈达铂(Nedaplatin,NDP)和替加氟(Tegafur,FT-207)联合化疗方案在局部晚期鼻咽癌诱导化疗中的近期疗效和毒副反应;探讨不同化疗方案结合常规放射治疗非远处转移鼻咽癌的疗效及毒副反应;探讨西妥昔单抗联合化放疗一线治疗晚期鼻咽癌的有效性和安全性。方法采用回顾性分析方法,收集我科60例初治的局部晚期鼻咽癌病例,归为改良PF方案组和常规PF方案组,每组30例,分别接受NDP+FT-207方案(NDP 30mg/m~2,d1-3;FT-207 600mg/m~2,d1-5;CF 0.2g,d1-5,每3周1次)和常规DDP+5-FU方案(DDP 30mg/m~2,d1-3;5-FU 500mg/m~2,d1-5;CF 0.2g,d1-5,每3周1次)诱导化疗,2周期化疗结束后行鼻咽部及颈部淋巴结常规放疗,观察各组的疗效和毒副反应,并进行统计学比较。回顾性分析157例非远处转移鼻咽癌患者,按与放疗结合的不同方式分为单纯放疗组24例(单放组)、诱导化疗组63例(诱导组)、辅助化疗组31例(辅助组)、诱导化疗+辅助化疗组39例(诱导+辅助组),放射治疗采用常规放射治疗,比较各组患者的近期疗效、生存情况、失败模式、预后因素和毒副反应。对1例晚期鼻咽癌伴弥漫性肝转移的患者予以3周期诱导化疗+4周期同期化放疗(鼻咽部加颈部淋巴结常规照射),在以上治疗同步加用西妥昔单抗每周1次静脉滴注,首剂400mg/m~2,以后每周250mg/m~2,共29周,观察其疗效及安全性。结果 1.改良PF方案组CR率83.3%,PR率13.3%;常规PF方案组CR率70%,PR率30%,两组比较差异无显著性意义(P0.05)。改良PF方案组III-IV度粒细胞减少发生率为6.6%,常规PF方案组为3.3%,但两组比较差异无显著性意义(P0.05)。改良PF方案组III-IV级恶心、呕吐发生率为6.7%,而常规PF方案组为26.7%,两组比较差异有显著性意义(P0.05)。 2.近期疗效分析结果显示,单纯放疗组、诱导化疗组、辅助化疗组、诱导化疗+辅助化疗组总有效率分别为95.8%、96.8%、96.7%和94.8%,差异无统计学意义(P=0.491);各组患者5年总生存率分别为56.4%、75%、62.9%和62.7% (P=0.845),无局部复发生存率分别为58%、66%、57%和69% ( P=0.734),无远处转移生存率分别为72%、73%、65%和71% (P=0.547)。T分期、N分期、临床分期、颈动脉鞘区侵犯是影响患者的独立预后因素。相关急性毒副反应主要有骨髓抑制、胃肠道反应和放射性皮肤黏膜炎。晚期副作用主要有口腔干燥症、龋齿及牙齿脱落和颈部皮下组织纤维化。 3.通过常规放化疗联合西妥昔单抗治疗,患者疗效评估为完全缓解(CR),鼻咽部原发病灶和肝脏的转移病灶均得到较好的控制。主要的副作用为:痤疮样皮疹、口腔黏膜反应及骨髓功能抑制。结论 1.奈达铂联合替加氟治疗局部晚期鼻咽癌有较好疗效,毒副反应较轻,值得在鼻咽癌诱导化疗中推广应用。 2.与单纯放射治疗相比,诱导化疗、辅助化疗以及两者组合方案均未能显著提高肿瘤无局部复发生存率、无远处转移生存率和总生存率,但在部分局部晚期鼻咽癌治疗中有获益趋势。 3.西妥昔单抗联合常规化放疗治疗晚期鼻咽癌效果满意,毒副作用未显著增加,值得临床扩大样本进一步证实。
[Abstract]:background Nasopharyngeal carcinoma (NPC) is a malignant tumor in the epithelial and mucosal glands of the nasopharynx. Performance. Mainly in the South, South-East Asia, Middle East and North Africa And so on. Radiotherapy is the most important treatment. The 5-year survival rate can reach more than 80%, but it is not ideal for locally advanced nasopharyngeal carcinoma with distant metastasis. In recent years, the local control rate of the nasopharynx and the neck has been greatly improved, and the quality of life after radiotherapy is also significant. The local control rate and overall survival rate of the local advanced nasopharyngeal carcinoma were improved, but the 5-year survival rate was still poor, local recurrence and distant metastasis were the main failure. Mode. At present, the concurrent radiotherapy has been confirmed in the treatment of locally advanced nasopharyngeal carcinoma, and the effect of induction chemotherapy and adjuvant chemotherapy still has more. Dispute. How to reduce the distance transfer and improve the overall life How to improve the survival rate? How to optimize the combination mode of radiotherapy and chemotherapy, and use the new drugs to improve the treatment performance The effect Objective To observe the recent curative effect and the side effect of Nedaplatin (NDP) and tegafur (FT-207) combined with chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Treatment of advanced nasopharyngeal carcinoma by the combination of cetuximab and radiotherapy in the treatment of advanced nasopharyngeal carcinoma to have The method used a retrospective analysis method to collect 60 cases of locally advanced nasopharyngeal carcinoma of the family, which was classified as an improved PF regimen group and a conventional PF regimen group. Each group received NDP + FT-207 regimen (NDP 30 mg/ m ~ 2, d1-3, FT-207 600 mg/ m ~ 2, d1, respectively). -5; CF 0.2 g, d1-5, once every 3 weeks) and conventional DDP + 5-FU regimen (DDP 30 mg/ m ~ 2, d1-3;5-FU 500 mg/ m ~ 2, d1-5; CF 0.2 g, d1-5, once every 3 weeks) induced chemotherapy, and the nasopharyngeal and cervical lymph nodes were treated with conventional radiotherapy at the end of 2-cycle chemotherapy to observe the efficacy of each group. A total of 157 patients with non-distant metastasis were analyzed retrospectively. Thirty-one (auxiliary group) of adjuvant chemotherapy group and 39 cases (induction + auxiliary group) of chemotherapy plus adjuvant chemotherapy group were induced by radiotherapy, and the recent curative effect and survival of the group were compared with the conventional radiotherapy. Case, failure mode, prognostic factors and side-to-side reaction. One patient with advanced nasopharyngeal carcinoma with diffuse liver metastasis was treated with 3-cycle induction chemotherapy plus 4-cycle concurrent radiotherapy (nasopharynx plus neck lymph node conventional irradiation), and the first dose of 400 mg/ m ~ 2.250 m every week g/ Results 1. The CR rate of the modified PF regimen was 83.3%, the PR rate was 13.3%, and the CR rate of the conventional PF regimen was 70%. The PR rate was 30%, and there was no significant difference between the two groups (P0.05). In the improved PF regimen, the incidence of nausea and vomiting was 6.7%, while the conventional PF regimen was not significant (P0.05). The results showed that the total effective rate of chemotherapy plus adjuvant chemotherapy group was 95.8%, 96.8%, 96.7% and 94.8%, respectively. The 5-year overall survival rate of each group was 56.4%,75%, 62.9% and 62.7% (P = 0.845), respectively. The survival rate of non-local recurrence was 58%,66%,57% and 69% (P = 0.734), and the survival rate of no distant metastasis was 72% and 73%, respectively. 65% and 71% (P = 0.547). T staging , N staging, clinical stage, and invasion of carotid artery and region are the independent prognostic factors that affect the patient. The response of the acute toxicity is mainly myelosuppression, gastrointestinal reaction, and mucositis of the radioactive skin. The side effects are mainly oral and dental caries, dental caries and tooth drop and neck subcutaneous tissue fibrosis.3. The efficacy of the patients is evaluated by the combination of conventional chemotherapy and chemotherapy with cetuximab. Complete response (CR), primary focus of the nasopharynx and metastatic focus of the liver were all obtained. -Okay.-Okay. Control. The main side effects were: skin rash, oral mucosa reaction and bone marrow function inhibition. In that treatment of locally advanced nasopharyngeal carcinoma, the treatment of the local advanced nasopharyngeal carcinoma has good curative effect, and the toxic side effect is light, and it is worth to be popularized and applied in the induction chemotherapy of the nasopharyngeal carcinoma.2. the induction chemotherapy, the adjuvant chemotherapy and the combination of the two combination can not significantly improve the tumor-free effect as compared with the simple radiation therapy. Local recurrence-free survival, no distant metastasis survival, and overall survival, but with a benefit trend in some locally advanced nasopharyngeal carcinoma treatment.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63

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