时辰化疗联合调强放射治疗局部晚期鼻咽癌的前瞻性临床研究

发布时间：2018-05-13 03:28

本文选题：鼻咽癌 + 时辰化疗　；参考：《贵州医科大学》2017年硕士论文

【摘要】：目的:比较时辰化疗与常规化疗联合调强放疗在局部晚期鼻咽癌患者治疗过程中的毒副反应、免疫功能、即刻疗效,期望在不降低临床疗效的基础上,能减少治疗相关毒副反应的发生、降低免疫功能的损伤,为传统的化疗药物找到一种新的应用模式。方法:将114例初治局部晚期鼻咽癌患者随机分为两组,时辰化疗组(chronomodulated chemotherapy with radiotherapy,CCR)患者(57例)多西他赛(DOC):75mg/m2,ivgtt,d1(03:30～04::30);顺铂(DDP):75mg/m2,civ,d1-d5(10:00-22:00);5-氟尿嘧啶(5-FU):750mg/m2/d1,泵内注入,d1-d5(22:00～10:00)。同步化疗:DDP100mg/m2,civ,d1(10:00～22:00);常规化疗组(routine-chemotherapy with radiotherapy,RCR)患者(57例)DOC:75mg/m2,ivgtt,d1;DDP:75mg/m2,ivgtt,第 1 天;5-FU:750mg/m2/d1,civ,d1-d5(持续泵入120小时)。同期化疗:DDP100mg/m2,ivgtt,d1。两组放疗均采用调强放射治疗,6MV-X,剂量:T1-2GTVnx 69.96 Gy/33f;T3-4 GTVnx 73.92Gy/33f,PTVnx 69.96Gy/33f,PGTVnd 69.96Gy/33f,PTV1 60.06Gy/33f,PTV2 50.96Gy/28f,1f/d,5f/w。即刻疗效评价采用Recisit 1.1 标准评价,CTC 3.0评价不良反应。用PASW statistics 22.0软件录入数据并进行结果分析。结果:时辰化疗组与常规化疗组的即刻疗效评价CR、PR、SD、PD差异无统计学意义(P0.05),两组有效率(CR+PR)差异无统计学意义(P0.05);时辰化疗组的白细胞计数、中性粒细胞计数、呕吐、口腔黏膜炎发生率显著低于常规化疗组(P0.05);时辰化疗组CD3+、CD4+/8+T细胞计数显著高于常规化疗组(P0.05)。结论:时辰化疗作为一种新的治疗模式,与调强放疗联合可在不降低临床疗效的同时减轻治疗相关副反应的发生率及严重程度,可改善免疫功能,值得临床推广及应用。
[Abstract]:Objective: to compare the toxic side effects, immune function, immediate effect of time chemotherapy and conventional chemotherapy combined with intensity modulated radiotherapy in the treatment of local advanced nasopharyngeal carcinoma patients. It can reduce the occurrence of toxic side effects and decrease the damage of immune function, and find a new application mode for traditional chemotherapeutic drugs. Methods: one hundred and forty four patients with locally advanced nasopharyngeal carcinoma were randomly divided into two groups: chemotherapy group (n = 57): docetaxel (n = 57) docetaxel (n = 75 mg / m ~ (2) ivgttd1010: 30: 30: 30; cisplatin DDP /% (75 mg / m ~ (2): civd1-d5 / 10: 00-22005-fluorouracil (5-FU) / 750mg / m ~ (2) / d ~ (-1). Synchronous chemotherapy: DDP 100 mg / m2civd1 10: 00 00: 00; routine chemotherapy group: routine-chemotherapy with radiotherapyr; 57 cases with DOC: 75mg / m2ivgtd1d1 DDP: 75mg / m2ivgtt. the first day 5-FU: 750mgm2d2civd1-d5 (continuously pumped 120 hours). Chemotherapy: DDP 100 mg / m 2 iv d 1. Both groups were treated with IMV X at the dose of: T1-2GTVnx 69.96Gy / 33fN T3-4 GTVnx 73.92Gy / 33fnx PGTVnd 69.96Gy / 33fPTV1 60.06Gy / 33fPTV250.96Gy / 28fdT / 5frw. The immediate efficacy was evaluated by Recisit 1.1 standard and CTC3.0 was used to evaluate adverse reactions. Input data with PASW statistics 22. 0 software and analyze the results. Results: there was no significant difference in the immediate curative effect between the two groups (P 0.05), but there was no significant difference in the effective rate between the two groups (P 0.05), while the leukocyte count, neutrophil count, vomiting in the hour chemotherapy group were not significantly different from those in the control group. The incidence of oral mucositis was significantly lower than that of routine chemotherapy group (P 0.05), and the CD3 CD4 / 8 T cell count in chemotherapy group was significantly higher than that in routine chemotherapy group (P 0.05). Conclusion: as a new treatment mode, time chemotherapy combined with intensity modulated radiotherapy can reduce the incidence and severity of side effects while not reducing the clinical efficacy. It can improve immune function and is worthy of clinical popularization and application.
【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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