局部晚期鼻咽癌吉西他滨和顺铂联合调强放疗Ⅱ期临床试验

doi:10.3760/cma.j.issn.1004-4221.2012.05.003

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摘要目的评价吉西他滨和顺铂与调强放疗序贯治疗局部晚期鼻咽癌的疗效和不良反应。方法 71例局部晚期鼻咽癌(Ⅲ期 41例、Ⅳ_A期 30例)患者接受新辅助化疗、调强放疗、辅助化疗,新辅助化疗、辅助化疗各2个疗程\[吉西他滨1000 mg/m²,第1、8天静脉滴注(>30 min);顺铂 25 mg/m²,第 1~3天,静脉滴注;21 d为1个疗程\]。调强放疗鼻咽大体肿瘤体积 66.0~70.4 Gy,颈部淋巴结大体肿瘤体积66 Gy, 临床高危靶体积60 Gy,临床低危靶体积54 Gy。结果新辅助化疗后的有效率为91.2%,主要急性不良反应为 1~2级骨髓抑制。所有患者随访满 3年,3年鼻咽局部控制率、区域控制率、无远处转移率、总生存率分别为93%、99%、91%、90%。3级晚期不良反应中张口困难 1例、听力下降 2例、颅神经损伤 2例。结论吉西他滨和顺铂联合调强放疗局部晚期鼻咽癌有效、方便、耐受性良好,值得进一步探索药物最适当的治疗周期。

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	欧丹
	何霞云
	胡超苏
	应红梅
	朱国培

关键词 ：鼻咽肿瘤/化学疗法, 鼻咽肿瘤/放射疗法, 化学疗法, 吉西他滨和顺铂, 放射疗法, 调强, 预后

Abstract：Objective To evaluate the efficacy and toxicity of gemcitabine plus cisplatin (GP) chemotherapy combined with intensity-modulated radiation therapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC). Methods 71 patients (Stage Ⅲ:41, Stage Ⅳ_A:30) with locoregionally advanced NPC were entered this study. Neoadjuvant chemotherapy was consisted of cisplatin 25 mg/m² intravenously on d1-3 and gemcitabine 1000 mg/m² in 30 minutes intravenous infusion on days 1 and 8, every 3 weeks for 2 cycles. Adjuvant chemotherapy consisted of 2 cycles of the same GP regimen was given at 28 days after the end of radiotherapy. The prescription doses was 66.0－70.4 Gy to the gross tumor volume, 66 Gy to positive neck nodes, 60 Gy to the high-risk clinical target volume, 54 Gy to the low-risk clinical target volume. Results The overall response rate to neoadjuvant chemotherapy was 91.2%,acute toxicity was mainly grade 1－2 myleosuppression. All patients completed IMRT. The median follow-up duration was 38 months. The 3-year nasopharyngeal local control, regional control, distant metastasis-free survival rate and overall survival rate were 93%, 99%, 91%, 90%, respectively. Severe late toxicities included grade 3 trismus in 1 patient, grade 3 hearing impairment in 2 patients and cranial nerve palsy in 2 patients, respectively. No grade 4 late toxicities were observed. Conclusions The combination of GP chemotherapy and IMRT for locoregionally advanced nasopharyngeal carcinoma is well-tolerated, convenient, effective, and warrants further studies of more proper cycles of GP regimen.

Key words： Nasopharyngeal neoplasms/chemotherapy Chemotherapy, cisplatin and gemcitabine Nasopharyngeal neoplasms/radiotherapy Radiotherapy, intensity-modulated Prognosis

收稿日期: 2012-01-15

引用本文:

欧丹,何霞云,胡超苏等. 局部晚期鼻咽癌吉西他滨和顺铂联合调强放疗Ⅱ期临床试验[J]. 中华放射肿瘤学杂志, 2012, 21(5): 412-414.

OU Dan,HE Xia-yun,HU Chao-su et al. Phase Ⅱ study of gemcitabine plus cisplatin chemotherapy combined with intensity modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2012, 21(5): 412-414.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2012.05.003 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2012/V21/I5/412

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