局部晚期鼻咽癌TPF方案诱导化疗加紫杉醇或顺铂同期IMRT疗效分析

doi:10.3760/cma.j.issn.1004-4221.2015.03.015

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Abstract Objective To evaluate the efficacy of docetaxel, cisplatin, and 5-fluorouracil (TPF)-based induction chemotherapy plus concurrent intensity-modulated radiotherapy (IMRT) with paclitaxel or cisplatin in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Methods From 2008 to 2012, 263 patients with locally advanced NPC were enrolled as subjects. A prescribed dose of 69.96-73.92 Gy in 33 fractions was applied to the primary nasopharyngeal gross tumor volume and the positive lymph nodes, 60.06 Gy in 33 fractions to the clinical target volume, and 50.96 Gy in 25 fractions to the negative lymphatic drainage volume. All patients were treated with two or three cycles of TPF-based induction chemotherapy (docetaxel 75 mg/m²;cisplatin 75 mg/m²;5-fluorouracil 750 mg/m²·d^－1), followed by two cycles of concurrent IMRT with paclitaxel (135 mg/m² on days 1 and 22) for 128 patients and with cisplatin (100 mg/m² on days 1 and 22) for 135 patients. The survival rates were calculated with the Kaplan-Meier method and analyzed by the log-rank test. Multivariate prognostic analysis was performed using the Cox regression model. Results With a sample size of 42 patients, the 5-year overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS) were 81.6%, 76.1%, 92.3%, 88.5%, and 80.4%, respectively. Patients treated with induction chemotherapy plus concurrent IMRT with cisplatin had significantly higher OS (93.5% vs. 74.7%, P=0.035), PFS (80.1% vs. 72.7%, P=0.034), LRFS (95.9% vs. 88.8%, P=0.020), and DMFS (83.5% vs. 77.5%, P=0.033) than those treated with concurrent IMRT with paclitaxel. Due to concurrent chemoradiotherapy, the incidence rates of grade ≥3 leucopenia, gastrointestinal reactions, oral mucositis, and radiodermatitis were 33.1%, 11.8%, 26.3%, and 11.1%, respectively. The incidence rates of grade 1 xerostomia, grade 2 xerostomia, grade 3 hearingloss, and grade 3 trismus were 50.3%, 12.6%, 3.4%, and 3.3%, respectively. ConclusionsCompared with TPF-based induction chemotherapy plus concurrent IMRT with paclitaxel, concurrent IMRT with cisplatin yields higher OS, PFS, LRFS, and DMFS as well as tolerable acute adverse reactions in the treatment of locally advanced NPC.

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	Articles by authors
	Ma Faqiang^*
	Jin Feng
	Wu Weili
	Li Yuanyuan
	Long Jinghua
	Lu Fangyang
	Bi Ting
	Li Zhuoling
	He Qianyong
	Qu Bo

Key words： Nasopharyngeal neoplasms/intensity-modulated radiotherapy Nasopharyngeal neoplasms/chemotherapy Induction chemotherapy Concurrent chemoradiotherapy Prognosis

Corresponding Authors: Jin Feng. Department of Head and Neck Oncology,Affiliated Hospital of Guiyang Medical College,Guiyang Tumor Hospital,Guiyang 550004,China;Email:jinf8865@yeah.net

Cite this article:

Ma Faqiang^*,Jin Feng,Wu Weili et al. Efficacy of induction chemotherapy with TPF plus concurrent IMRT with paclitaxel or cisplatin in treatment of locally advanced nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2015, 24(3): 290-294.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2015.03.015 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2015/V24/I3/290

[1] 邓伟,黄天壬,陈万青,等.中国2003—2007年鼻咽癌发病与死亡分析[J].肿瘤,2012,32(3):189-193.DOI:10.3781/j.issn.1000-7431.2012.03.007.
[2] 苏胜发,赵充,韩非,等.鼻咽癌适形调强放疗远期疗效分析[J].中华肿瘤防治杂志,2013,20(11):853-858.
[3] 肖魏巍,卢泰祥,赵充,等.调强放疗技术对鼻咽癌UICC/AJCC分期的影响[J].中华放射肿瘤学杂志,2010,19(3):181-184. DOI:10.3760/cma.j.issn.1004-4221.2010.03.002.
[4] Lee AW, Tung SY, Chua DT, et al. randomized trial of radiotherapy Plus concurrent-Adjuvant chemotherapy vs. radiotherapy alone for regionally advanced nasopharyngeal carcinoma[J]. J Nat Cancer Inst,2010,102(15):1188-1198. DOI:10.1093/jnci/djq258.
[5] 胡福军,陈晓忠,姜锋,等.局部晚期鼻咽癌调强放疗联合化疗135例临床分析[J].中华肿瘤防治杂志,2012,19(12):917-920.
[6] Lee AW, Sze W, Au JS, et al. Treatment results for nasopharyngeal carcinoma in the modern era:the Hong Kong experience[J]. Int J Radiat Oncol Biol Phys,2005,61(4):1107-1116.
[7] Gao Y, Hu C, Ying H, et al. Treatment results of nasopharyngeal carcinoma:a retrospective analysis of 1837 cases in a single institute[J]. Chin J Radiat Oncol,2008,17(5):335-339.
[8] 高剑铭,曾益新,崔念基,等.915例单纯根治性放疗鼻咽癌分期系统比较及建议(一)——对′92福州分期的校验[J].癌症,2005,24(10):1165-1172.DOI:10.3321/j.issn:1000-467X.2005.10.001.
[9] Thephamongkhol K, Zhou J, Browman G, et al. Chemo-radiotherapy versus radiotherapy alone for nasopharyngeal carcinoma:a meta-analysis of 78 randomized controlled trials (RCTs) from English and non-English databases[J]. J Clin Oncol,2004,22(14 Suppl):5522.
[10] Chua DT, Ma J, Sham JS, et al. Long-term survival after cisplatin-based induction chemotherapy and radiotherapy for nasopharyngeal carcinoma:a pooled data analysis of two phase Ⅲ trials[J]. J Clin Oncol,2005,23(6):1118-1124.
[11] Mumme AM, Reitmeier F, Knecht R. The current value of induction chemotherapy. ASCO Congress 2010[J]. HNO,2010,58(12):1156,1158,1160-1162.DOI:10.1007/s00106-010-2201-z.
[12] Clairambault J. Modeling oxaliplatin drug delivery to circadian rhythms in drug metabolism and host tolerance[J]. Adv Drug Deliv Rev,2007,59(9-10):1054-1068.DOI:10.1016/j.addr.2006.08.004.
[13] Posner MR, Hershock DM, Blajman CR, et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer[J]. N Engl J Med,2007,357(17):1705-1715.DOI:10.1056/NEJMoa070956.
[14] Vermorken JB, Remenar E, Van Herpen C, et al. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer[J]. N Engl J Med,2007,357(17):1695-1704.DOI:10.1056/NEJMoa071028.
[15] Bae WK, Hwang JE, Shim HJ, et al. Phase Ⅱ study of docetaxel, cisplatin, and 5-FU induction chemotherapy followed by chemoradiotherapy in locoregionally advanced nasopharyngeal cancer[J]. Cancer Chemother Pharmacol,2010,65(3):589-595. DOI:10.1007/s00280-009-1152-0.
[16] Huang Z, Feng J, Li S, et al. Is the Neoadjuvant Docetaxel, Cisplatin and 5-Fluorouracil regimen superior to classic Cisplatin and 5-Fluorouracil for locoregionally advanced nasopharyngeal carcinoma?[J]. J Cancer Res Updates,2013,2(4):297-305.DOI:10.6000/1929-2279.2013.02.04.8.
[17] 易俊林,高黎,黄晓东,等.416 例鼻咽癌调强放疗远期生存与影响因素分析[J].中华放射肿瘤学杂志,2012,21(3):196-200. DOI:10.3760/cma.j.issn.1004-4221.2012.03.002.
[18] 冯梅,范子煊,黎杰,等.头颈部肿瘤暨鼻咽癌的分子靶向临床研究进展[J].肿瘤预防与治疗,2013,26(1):1-3. DOI:10.3969/j.issn.1674-0904.2013.01.001.
[19] Inuyama Y, Kataura A, Togawa K, et al.[Late phase Ⅱ clinical study of RP56976(docetaxel) in patients with advanced/recurrent h[1, 2]ead and neck cancer][J]. Gan To Kagaku Ryoho,1999,26(1):107-116.
[20] Al-Sarraf M, Leblanc M, Giri P, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer:phase Ⅲ randomized intergroup study 0099[J]. J Clin Oncol,1998,16(4):1310-1317.
[21] Han L, Lin SJ, Pan JJ, et al. Prognostic factors of 305 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J]. Chin J Cancer,2010,29(2):145-150.
[22] Kong L, Zhang YW, Hu CS, et al. Neoadjuvant chemotherapy followed by concurrent chemoradiation for locally advanced nasopharyngeal carcinoma[J]. Chin J Cancer,2010,29(5):551-555.DOI:10.1002/cncr.28324.
[23] Kam MK, Teo PM, Chau RM, et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy:the Hong Kong experience[J]. Int J Radiat Oncol Biol Phys,2004,60(5):1440-1450.DOI:10.1016/j.ijrobp.2004.05.022.
[24] Kwong DL, Sham JS, Leung LH, et al. Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma[J]. Int J Radiat Oncol Biol Phys,2006,64(2):374-381.DOI:10.1016/j.ijrobp.2005.07.968.