时辰化疗联合调强放射治疗对局部晚期鼻咽癌患者生命质量和营养状况的影响

发布时间：2018-03-22 14:34

本文选题：鼻咽癌　切入点：时辰化疗　出处：《贵州医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察时辰化疗联合调强放疗与常规化疗联合调强放疗对局部晚期鼻咽癌患者生命质量和营养状况的影响。预期时辰化疗组较常规化疗组更能降低患者化疗带来的不良反应,患者具有相对较高的生命质量和营养状态,为局部晚期鼻咽癌患者提供一种更合理的治疗方式。方法:将85例鼻咽癌患者随机分为试验组(42例)和对照组(43例)。试验组(时辰组)诱导化疗及同步化疗时在固定时间采用电子化疗全自动注药泵静脉泵入给药,TPF诱导化疗:多西他赛 75mg/m2,03:30-04:30,静脉滴注,d1;顺铂 75mg/m2,10:00-22:00,持续泵入,d1-5;5-氟尿嘧啶750mg/m2/d,22:00-10:00,持续泵入,d1-5;同步化疗:单药顺铂100mg/m2,10:00-22:00,持续泵入,d1,对照组(常规组)采用常规静滴方式,TPF诱诱导化疗:多西他赛75mg/m2,静脉滴注,d1;顺铂75mg/m2,静脉滴注,d1:5-氟尿嘧啶750mg/m2/d,持续泵入,d1-5;同步化疗:单药顺铂100mg/m2,静脉滴注,d1)。同步放疗均采用调强放射治疗(IMRT),鼻咽原发灶剂量T1-2:PGTVnx DT=69.96Gy/33f,T3-4:PGTVnx DT=73.92Gy/33f,PTVnx DT=69.96Gy/33f,PGTVnd DT=69.96Gy/33f,PGTVrpn DT=69.96Gy/33f,PTV1 DT=60.06Gy/33f,PTV2 DT=50.96Gy/28f。运用癌症患者生活质量测定量表EORTC QLQ-C30、头颈肿瘤患者专用生活质量问卷表EORTC QLQ-HN35和营养状况筛查表NRS-2002、患者主观自评表PG-SGA观察两组不同给药模式放化疗前后患者生命质量和营养状况的差别。采用SPSS 19.0统计分析软件包进行数据录入及统计分析。结果:①在治疗前将两组患者基线资料进行对比,两组患者临床特征差异无统计学意义(P0.05)。②在经过2周期诱导化疗后时辰化疗组患者总体健康状况及降低消化道反应(恶心呕吐、食欲丧失、便秘、吞咽困难、体重增加领域得分较常规组低)明显好于常规化疗组,差异有统计学意义(P0.05);时辰化疗组患者在疲倦、失眠、疼痛、气促等领域得分也低于常规化疗组患者,但差异无统计学意义(P0.05)。在同步放化疗治疗结束时时辰化疗组患者在社会功能、总健康状况、降低恶心与呕吐等领域明显好于常规化疗组,差异有统计学意义(P0.05)。③NRS2002调查显示时辰化疗组治疗前、诱导化疗后、同步放化疗结束存在营养风险患者分别为2例、2例和36例;常规化疗组分别为5例、7例和36例。PG-SGA评估可得出时辰化疗组治疗前、诱导化疗后、同步放化疗结束发生营养不良患者分别为15例、28例和42例;常规化疗组分别为18例、31例和42例。患者在治疗后发生营养不良明显增加,且常规组增加病例数多于时辰组。结论:时辰化疗组与常规化疗组相比能明显减轻恶心呕吐、食欲丧失、便秘等不良反应,使时辰化疗组患者总体健康状况及生命质量无明显下降,较常规化疗组好。患者在经过治疗后营养不良发生率增高。两个生命质量问卷表及两个营养风险筛查表易操作,可行性好,患者均可理解,并配合完成率高。局部晚期鼻咽癌患者采用时辰化疗可能较常规化疗成为一种更合理的治疗模式。
[Abstract]:Objective: To observe the effect of chemotherapy combined with intensity modulated radiotherapy and conventional chemotherapy combined with radiotherapy for locally advanced nasopharyngeal cancer patients life quality and nutritional status. The expected Chrono chemotherapy group than the conventional chemotherapy group can reduce the adverse reaction of patients with chemotherapy, patients with relatively high quality of life and nutritional status, to provide a more reasonable the treatment for patients with locally advanced nasopharyngeal carcinoma. Methods: 85 cases of nasopharyngeal carcinoma patients were randomly divided into experimental group (42 cases) and control group (43 cases). The experimental group (Chrono group) by electronic automatic infusion pump intravenous chemotherapy pump infusion at a fixed time of induction chemotherapy and concurrent chemotherapy, induced by TPF 75mg/m2,03:30-04:30: docetaxel chemotherapy, intravenous infusion of cisplatin, D1; 75mg/m2,10:00-22:00, D1-5; 5- continuous infusion of fluorouracil, 750mg/m2/d, 22:00-10:00, continuous infusion, D1-5; chemotherapy: single drug cisplatin 100mg/m2,10 00-22:00, continuous infusion, D1, control group (routine group) with routine intravenous drip, TPF induced induction chemotherapy: Docetaxel 75mg/m2, intravenous infusion of cisplatin, D1; 75mg/m2, intravenous drip, d1:5- fluorouracil 750mg/m2/d, continuous infusion, D1-5; chemotherapy: single drug cisplatin 100mg/m2, intravenous drip, D1). Radiotherapy using intensity-modulated radiation therapy (IMRT), primary nasopharyngeal dose of T1-2:PGTVnx DT=69.96Gy/33f, T3-4:PGTVnx DT=73.92Gy/33f, PTVnx DT=69.96Gy/33f, PGTVnd DT=69.96Gy/33f, PGTVrpn DT=69.96Gy/33f, PTV1 DT=60.06Gy/ 33F, PTV2 DT=50.96Gy/28f. with cancer patients quality of life measuring scale EORTC QLQ-C30, patients with head and neck cancer specific quality of life questionnaire and EORTC QLQ-HN35 the nutritional status of patients with NRS-2002 screening, subjective self rating Anxiety Scale PG-SGA were observed in two groups of different administration modes before and after radiotherapy and chemotherapy patients life quality and nutritional status were different by SPS. S 19 statistical analysis software package for data entry and statistical analysis. Results: before the treatment the two groups of patients with baseline data were compared, no significant difference between the two groups (P0.05). The clinical features after 2 cycles of induction chemotherapy after the overall health of patients when chemotherapy and reduce gastrointestinal reactions (nausea and vomiting, loss of appetite, constipation, dysphagia, weight gain scores lower than the conventional group) was significantly better than the conventional chemotherapy group, the difference was statistically significant (P0.05); the Chrono chemotherapy group in patients with insomnia, fatigue, pain, shortness of breath, the field is lower than the score in the conventional chemotherapy group, but the difference was not statistically significant (P0.05). At the end of radiotherapy and chemotherapy in the treatment of patients with the Chrono chemotherapy group in social function, general health status, reduce nausea and vomiting and other fields are significantly better than the conventional chemotherapy group, the difference was statistically significant (P0.05). The NRS2002 survey Show the Chrono chemotherapy group before treatment, after induction chemotherapy, radiotherapy and chemotherapy are the end of nutritional risk patients were 2 cases, 2 cases and 36 cases; conventional chemotherapy group were 5 cases, 7 cases and 36 cases of.PG-SGA can be obtained to evaluate the Chrono chemotherapy group before treatment, after induction chemotherapy, radiotherapy and chemotherapy end of nutrients patients were 15 cases, 28 cases and 42 cases; conventional chemotherapy group were 18 cases, 31 cases and 42 cases. Patients in the treatment after the incidence of malnutrition increased significantly, and increase the number of cases than the conventional group hour group. Conclusion: Chrono chemotherapy group compared with the conventional chemotherapy group can significantly reduce nausea and vomiting. Loss of appetite, constipation and other adverse reactions, the Chrono chemotherapy group patients overall health and quality of life decreased significantly, compared with the conventional chemotherapy group. The patients after treatment for malnutrition rate increased two. The quality of life questionnaire and two nutritional risk screening table easily The operation is feasible, and the patients can understand and cooperate with the completion rate. The local advanced nasopharyngeal carcinoma patients with chronopharyngeal chemotherapy may become a more reasonable treatment mode than conventional chemotherapy.

【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.63

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