中国肿瘤临床
中國腫瘤臨床
중국종류림상
CHINESE JOURNAL OF CLINICAL ONCOLOGY
2015年
14期
709-715
,共7页
毛振华%金风%吴伟莉%李媛媛%龙金华%龚修云%陈潇潇%李卓玲毕婷%贺前勇%瞿波%黄诗颖%陈宇%Yu CHEN
毛振華%金風%吳偉莉%李媛媛%龍金華%龔脩雲%陳瀟瀟%李卓玲畢婷%賀前勇%瞿波%黃詩穎%陳宇%Yu CHEN
모진화%금풍%오위리%리원원%룡금화%공수운%진소소%리탁령필정%하전용%구파%황시영%진우%Yu CHEN
鼻咽癌%时辰化疗%不良反应%淋巴细胞亚群
鼻嚥癌%時辰化療%不良反應%淋巴細胞亞群
비인암%시신화료%불량반응%림파세포아군
nasopharyngeal carcinoma%chrono-chemotherapy%adverse reaction%lymphocyte subsets
目的：研究TPF（多西他赛+顺铂+5-氟脲嘧啶）方案时辰化疗较常规化疗治疗初治远处转移鼻咽癌在减轻毒性、降低免疫功能损害方面是否具有优势。方法：选取贵州省肿瘤医院2012年12月至2014年10月46例初治远处转移（UICC 2010分期Ⅳc期）鼻咽癌患者入组。随机分为时辰组23例及常规组23例。均采用TPF方案诱导化疗2个周期，21~28 d/周期。时辰组：DTX 75 mg/m2静滴3～4 h d1（DDP前使用）；DDP 75 mg/m2持续静脉泵入d1～5，10 am～10 pm；5-FU 750 mg/（m2·d）持续静脉泵入d1～5，10 pm～10 am。常规组：DTX 75 mg/m2静滴3～4 h d1（DDP前使用）；DDP 75 mg/m2静滴d1；5-FU 750 mg/（m2·d）持续静滴d1～5，共120 h。化疗后评价有效者行三维适形调强放疗（IMRT），同期行顺铂单药增敏化疗（100 mg/m2静滴d1～2，21 d/周期，共2个周期。放化疗结束1个月后行辅助化疗：方案及方法同诱导化疗，共2个周期。不良反应按CTCAE v3.0评价系统分级，临床疗效参照2000年实体瘤疗效评价标准（RECIST）评价，有效率为CR+PR。结果：2级以上呕吐发生率常规组高于时辰组，差异有统计学意义（P<0.05）。化疗后时辰组CD4/CD8升高，常规组CD4/CD8降低（P<0.05）。结论：时辰化疗能够降低严重呕吐的发生率，在减少严重骨髓抑制方面可能存在优势，可能改善了患者的免疫功能。
目的：研究TPF（多西他賽+順鉑+5-氟脲嘧啶）方案時辰化療較常規化療治療初治遠處轉移鼻嚥癌在減輕毒性、降低免疫功能損害方麵是否具有優勢。方法：選取貴州省腫瘤醫院2012年12月至2014年10月46例初治遠處轉移（UICC 2010分期Ⅳc期）鼻嚥癌患者入組。隨機分為時辰組23例及常規組23例。均採用TPF方案誘導化療2箇週期，21~28 d/週期。時辰組：DTX 75 mg/m2靜滴3～4 h d1（DDP前使用）；DDP 75 mg/m2持續靜脈泵入d1～5，10 am～10 pm；5-FU 750 mg/（m2·d）持續靜脈泵入d1～5，10 pm～10 am。常規組：DTX 75 mg/m2靜滴3～4 h d1（DDP前使用）；DDP 75 mg/m2靜滴d1；5-FU 750 mg/（m2·d）持續靜滴d1～5，共120 h。化療後評價有效者行三維適形調彊放療（IMRT），同期行順鉑單藥增敏化療（100 mg/m2靜滴d1～2，21 d/週期，共2箇週期。放化療結束1箇月後行輔助化療：方案及方法同誘導化療，共2箇週期。不良反應按CTCAE v3.0評價繫統分級，臨床療效參照2000年實體瘤療效評價標準（RECIST）評價，有效率為CR+PR。結果：2級以上嘔吐髮生率常規組高于時辰組，差異有統計學意義（P<0.05）。化療後時辰組CD4/CD8升高，常規組CD4/CD8降低（P<0.05）。結論：時辰化療能夠降低嚴重嘔吐的髮生率，在減少嚴重骨髓抑製方麵可能存在優勢，可能改善瞭患者的免疫功能。
목적：연구TPF（다서타새+순박+5-불뇨밀정）방안시신화료교상규화료치료초치원처전이비인암재감경독성、강저면역공능손해방면시부구유우세。방법：선취귀주성종류의원2012년12월지2014년10월46례초치원처전이（UICC 2010분기Ⅳc기）비인암환자입조。수궤분위시신조23례급상규조23례。균채용TPF방안유도화료2개주기，21~28 d/주기。시신조：DTX 75 mg/m2정적3～4 h d1（DDP전사용）；DDP 75 mg/m2지속정맥빙입d1～5，10 am～10 pm；5-FU 750 mg/（m2·d）지속정맥빙입d1～5，10 pm～10 am。상규조：DTX 75 mg/m2정적3～4 h d1（DDP전사용）；DDP 75 mg/m2정적d1；5-FU 750 mg/（m2·d）지속정적d1～5，공120 h。화료후평개유효자행삼유괄형조강방료（IMRT），동기행순박단약증민화료（100 mg/m2정적d1～2，21 d/주기，공2개주기。방화료결속1개월후행보조화료：방안급방법동유도화료，공2개주기。불량반응안CTCAE v3.0평개계통분급，림상료효삼조2000년실체류료효평개표준（RECIST）평개，유효솔위CR+PR。결과：2급이상구토발생솔상규조고우시신조，차이유통계학의의（P<0.05）。화료후시신조CD4/CD8승고，상규조CD4/CD8강저（P<0.05）。결론：시신화료능구강저엄중구토적발생솔，재감소엄중골수억제방면가능존재우세，가능개선료환자적면역공능。
Objective:To investigate the outcomes of the regimen with docetaxel, cisplatin, and 5-fluorouracil (TPF regimen) in chrono-chemotherapy, and evaluate the feasibility of reducing the toxicity and immunological damage in nasopharyngeal carcinoma (NPC) patients with distant metastasis at preliminary diagnosis, then to compare the advantages and disadvantages between chrono-che-motherapy and traditional chemotherapy. Methods:A total of 46 NPC patients with distant metastasis at preliminary diagnosis (UICC 2010 stage IVc) were enrolled in this study. These NPC patients were randomly divided into chrono-chemotherapy and conventional chemotherapy groups, with 23 cases for each group. TPF neo-adjuvant chemotherapy was conducted in both groups for two cycles, with 21 days to 28 days for each cycle. The following regimen was used for the chrono-chemotherapy group:docetaxel 75 mg/m2, infu-sion, d1;cisplatin 75 mg/m2, 10:00 a.m.-10:00 p.m., continuous infusion, d1-d5;and fluorouracil 750 mg/(m2 · d), 10:00 p.m.-10:00 a. m., continuous intravenous infusion, d1-d5. The following regimen was used for the conventional chemotherapy group:docetaxel 75 mg/m2, infusion, d1;cisplatin 75 mg/m2, infusion, d1;and fluorouracil 750 mg/(m2· d), continuous infusion, d1-d5, 120 h. Patients who obtained therapeutic efficacy via induction chemotherapy were provided with intensity-modulated radiotherapy as a concurrent radio-therapy and chemotherapy (DDP 100 mg/m2, infusion, d1-d2, with 21 days each cycle and a total of two courses). One month after con-current chemoradiation, an adjuvant chemotherapy with the same regimen as the induction chemotherapy was employed for a total of two courses. Acute and late toxicities were graded in accordance with the Common Terminology Criteria for Adverse Events v3.0 scor-ing. Tumor response was evaluated using the 2000 Response Evaluation Criteria in Solid Tumors. The effective rates included complete and partial responses. Relevant data were analyzed by SPSS16.0 statistical software. Results:More emesis was observed at Grade 2 or above in the conventional chemotherapy group than in the chrono-chemotherapy group, with statistical significance between the two groups (P=0.035). After chemotherapy, the value of CD4/CD8 increased in the chrono-chemotherapy group and decreased in the con-ventional chemotherapy group, with statistical significance between the two groups (P=0.033). Conclusion:The proposed chrono-che-motherapy outperforms conventional chemotherapy in reducing the occurrence of severe vomiting. This chrono-chemotherapy may be advantageous in reducing severe bone marrow depression and may play a positive role in the immune function of NPC patients.
