CAJ | 학술논문

目的观察Ⅲ期、Ⅳa期鼻咽癌放疗同步两种化疗方法的近期效果及其毒副作用.方法将150例确诊为Ⅲ期、Ⅳa期鼻咽癌患者随机分为同步放化疗A组75例和同步放化疗B组75例,两组均给予根治性调强放疗,A组在放疗的同时予2个周期(21 ～ 28 d/周期)化疗,紫杉醇135 mg/m2+顺铂80 mg/m2方案;B组放疗同时给予每周1次顺铂30 mg/m2同步化疗,共化疗6周期.观察两种化疗方法的近期效果及其毒副作用.结果 (1)放疗结束后A组与B组原发病灶完全缓解(CR)率分别为68.0％(51/75)与52.0％ (39/75),颈部淋巴结CR率分别为64.0％(48/75)与48.0％(36/75),原发病灶并且颈部病变淋巴结CR率分别为45.3％(34/75)与20.0％(15/75),差异均有统计学意义(x2值分别为4.25、3.90、10.94,P均＜0.05);放疗后3个月复查A组与B组原发病灶CR率、颈部淋巴结CR率、原发病灶并且颈部病变淋巴结CR率差异均无统计学意义(P均＞0.05).(2)治疗期间毒副作用:A组与B组Ⅲ度骨髓抑制发生率分别为38.67％(29/75)与21.33％(16/75),Ⅲ度消化道反应发生率分别为21.33％(16/75)与6.67％ (5/75),Ⅲ度口腔黏膜损伤发生率分别为46.66％(35/75)与21.33％(16/75),Ⅲ度放射性皮肤损伤发生率分别为21.33％ (16/75)与9.34％ (7/75),差异均有统计学意义(P均＜0.05).(3)短期随访结果:随访1～3年,两组局部复发率及远处转移率差异无统计学意义(P＞0.05).结论放疗同步紫杉醇135 mg/m2+顺铂80 mg/m2化疗组与放疗同步顺铂30 mg/m2同步化疗组比较,治疗期间紫衫醇+顺铂组毒副作用较单纯顺铂组大,但近期疗效观察未见明显差异,远期疗效有待进一步评估.
목적 관찰Ⅲ기、Ⅳa기비인암방료동보량충화료방법적근기효과급기독부작용.방법 장150례학진위Ⅲ기、Ⅳa기비인암환자수궤분위동보방화료A조75례화동보방화료B조75례,량조균급여근치성조강방료,A조재방료적동시여2개주기(21 ～ 28 d/주기)화료,자삼순135 mg/m2+순박80 mg/m2방안;B조방료동시급여매주1차순박30 mg/m2동보화료,공화료6주기.관찰량충화료방법적근기효과급기독부작용.결과 (1)방료결속후A조여B조원발병조완전완해(CR)솔분별위68.0％(51/75)여52.0％ (39/75),경부림파결CR솔분별위64.0％(48/75)여48.0％(36/75),원발병조병차경부병변림파결CR솔분별위45.3％(34/75)여20.0％(15/75),차이균유통계학의의(x2치분별위4.25、3.90、10.94,P균＜0.05);방료후3개월복사A조여B조원발병조CR솔、경부림파결CR솔、원발병조병차경부병변림파결CR솔차이균무통계학의의(P균＞0.05).(2)치료기간독부작용:A조여B조Ⅲ도골수억제발생솔분별위38.67％(29/75)여21.33％(16/75),Ⅲ도소화도반응발생솔분별위21.33％(16/75)여6.67％ (5/75),Ⅲ도구강점막손상발생솔분별위46.66％(35/75)여21.33％(16/75),Ⅲ도방사성피부손상발생솔분별위21.33％ (16/75)여9.34％ (7/75),차이균유통계학의의(P균＜0.05).(3)단기수방결과:수방1～3년,량조국부복발솔급원처전이솔차이무통계학의의(P＞0.05).결론 방료동보자삼순135 mg/m2+순박80 mg/m2화료조여방료동보순박30 mg/m2동보화료조비교,치료기간자삼순+순박조독부작용교단순순박조대,단근기료효관찰미견명현차이,원기료효유대진일보평고.
Objective To explore the short term treatment effectiveness and the side-effect of radiotherapy combined with two kinds of chemotherapy scheme on nasopharyngeal carcinoma patients with stage Ⅲ and Ⅳa.Methods One hundred and fifty nasopharyngeal carcinoma cases with stage Ⅲ/Ⅳa were randomly divided into A and B group.Patients in A group (75 cases) were received radiotherapy combined with 2 courses ((21-28) d/course) paclitaxel (135 mg/m2) + cis-platinum complexes (DDP) 80 mg/m2 chemotherapy concurrently,while patients in B group (75 cases) were received radiotherapy combined with 6 courses DDP 30 mg/m2 per week chemotherapy concurently.The short term treatment effectiveness and the sideeffect of radiotherapy combined with two kinds of chemotherapy scheme were observed.Result After the treatment,the primary lesion complete remission(CR) rate in A group and B group were 68％ (51/75),52％ (39/75).The CR rate of lymph node of neck in A and B group was 64.0％ (48/75),48.0％ (36/75) and 45.3％ (34/75),20.0％ (15/75) of primary lesion and lymph node of neck.The differences were significant(x2=4.25,3.90,10.94 ;P ＜0.05).After 3 months of treatment,there was no significant difference between A and B group in terms of CR rate of the primary lesion,lymph node of neck and primary lesion and lymph node of neck (P ＞0.05).During the treatment,the rate of bone marrow depression at grade Ⅲ in A group and B group were 38.67％ (29/75) and 21.33％ (16/75),21.33％ (16/75) and 6.67％ (5/75) in terms of the rate of grade gastrointestinal reaction at stage Ⅲ,46.66％ (35/75) and 21.33％ (16/75) regarding of oral cavity mucomembranous injury at stage Ⅲ,21.33％ (16/75) and 9.34％ (7/75) in terms of the rate of radioactivity skin destruction at stage Ⅲ.All differences were significant (P ＜ 0.05).During the short-term follow up (1-3 years),both the rate of local recurrence and the rate of metastasis in A group was as same as that in B group(P ＞0.05).Conclusion During the treatment,the side-effect of approach of paclitaxel (135 mg/m2) + DDP 80 mg/m2 in stage Ⅲ/Ⅳa nasopharyngeal carcinoma patients is more severity than that of DDP 30 mg/m2 per week chemotherapy.However,there is no significant difference in terms of the short term treatment effectiveness.The prospective efficacy needs to be further investigation.