CAJ | 학술논문

目的探讨多西紫杉醇(TAX)、顺铂(DDP)、5-氟尿嘧啶(5-Fu)三药联合方案诱导化疗加DDP同期放化疗治疗晚期鼻咽癌的近期疗效及可行性.方法 40例初诊局部晚期(UICC分期Ⅲ、Ⅳ期)鼻咽癌患者人组,随机分为诱导化疗加DDP 3周方案组(A组),诱导化疗加DDP单周方案组(B组).两组均先行2个疗程诱导化疗,方案为TAX 60 mg/m2第1天;DDP 60 mg/m2第1天;5-Fu 600 mg/m2第1天至第5天,每3周重复,共2个周期.第7周开始放疗,放疔第1天同时行化疗.A组:DDP 80mg/m2第1天,每3周1次,共2次;B组:DDP 30mg/m2第1天,每周1次,共6次.放疗采用二维适形照射,鼻咽原发病灶68～72Gy,34～36次,7周,颈部淋巴结阳性区60～66Gy,30～33次,6～6.5周.结果 40例共完成78个疗程诱导化疗,A、B组各1例出组.38例可评价疗效和不良反应.A组17例完成2个疗程同期DDP化疗;B组10例按计划完成6个周同期化疗,4例完成5周化疗,4例完成4周化疗,1例只完成2周化疗.诱导化疗后CR 4例(10.5%),PR 27例(71.1%),SD 7例(18.4%),总有效(CR+PR)率81.6%.治疗结束后CR 32例(84.2%),PR 5例(13.2%),SD 1例(2.6%),总有效率97.4%.结论 TPF诱导化疗加DDP同期放化疗是治疗晚期鼻咽癌的可行方案,推荐使用同期DDP 3周化疗方案.剂量强度可否提高,有待进一步研究.
목적 탐토다서자삼순(TAX)、순박(DDP)、5-불뇨밀정(5-Fu)삼약연합방안유도화료가DDP동기방화료치료만기비인암적근기료효급가행성.방법 40례초진국부만기(UICC분기Ⅲ、Ⅳ기)비인암환자인조,수궤분위유도화료가DDP 3주방안조(A조),유도화료가DDP단주방안조(B조).량조균선행2개료정유도화료,방안위TAX 60 mg/m2제1천;DDP 60 mg/m2제1천;5-Fu 600 mg/m2제1천지제5천,매3주중복,공2개주기.제7주개시방료,방정제1천동시행화료.A조:DDP 80mg/m2제1천,매3주1차,공2차;B조:DDP 30mg/m2제1천,매주1차,공6차.방료채용이유괄형조사,비인원발병조68～72Gy,34～36차,7주,경부림파결양성구60～66Gy,30～33차,6～6.5주.결과 40례공완성78개료정유도화료,A、B조각1례출조.38례가평개료효화불량반응.A조17례완성2개료정동기DDP화료;B조10례안계화완성6개주동기화료,4례완성5주화료,4례완성4주화료,1례지완성2주화료.유도화료후CR 4례(10.5%),PR 27례(71.1%),SD 7례(18.4%),총유효(CR+PR)솔81.6%.치료결속후CR 32례(84.2%),PR 5례(13.2%),SD 1례(2.6%),총유효솔97.4%.결론 TPF유도화료가DDP동기방화료시치료만기비인암적가행방안,추천사용동기DDP 3주화료방안.제량강도가부제고,유대진일보연구.
Objective To assess the efficacy and feasibility of neoadjuvant therapy of TPF regimen including docetaxel (TAX), cisplatin (DDP) and 5-fluorouracil (5-Fu) combined with concurrent DDP and radiotherapy (RT) in patients with local advanced nasopharyngeal carcinoma (NPC). Methods From April 2008 to May 2009, 40 patients with newly diagnosed UICC stage Ⅲ orⅣ local advanced NPC were enrolled. Patients were randomly assigned to group A(DDP every 3 weeks) and group B(DDP every week). Two cycles of induction chemotherapy with TAX 60 mg/m2 dl, DDP 60 mg/m3 dl and 5-Fu 600 mg/m2 dl-5 were given on a 3-weekly cycle, followed by RT and chemotherapy(group A: DDP 80 mg/m2 every 3 weeks for 2 times; group B: DDP 30 mg/m2 weekly for 6 times). Two-dimension conformal RT technique with 68-72 Gy/(34-36) fractions for 7 weeks was administered to the nasopharynx and 60-66 Gy/(30-33) fractions for 6-6.5 weeks to the node-positive area. Results 38 patients (78 Cycles) were evaluable for efficacy and toxicity. One patient in each group was excluded due to toxicity. 17 (17/19) patients of group A finished 2 cycles of planed DDP chemotherapy, while only 10 (10/19) patients of group B completed 6 weeks of planed DDP chemotherapy, 4 completed 5 weeks, 4 completed 4 weeks and 1 completed 2 weeks. Response to neoadjuvant TPF was as follows: 4 patients (10.5 %) achieved complete response(CR), 27(71.1%) achieved partial response(PR) and 7 (18.4 %) achieved stable disease (SD), so the overall response (CR+PR) rate was 81.6 %. After RT, 32 patients (84.2 %) achieved CR, 5 (13.2 %) PR and 1 (2.6 %) SD, so the overall response rate was 97.4 %. Conclusion TPF induction chemotherapy followed by concurrent DDP and RT is an effective regimen in the treatment of advanced NPC. Concurrent DDP chemotherapy on a 3-weekly cycle is recommended. Further study should be made to investigate how to increase the dose intensity of chemotherapy.