【摘要】：背景 鼻咽癌(nasopharyngeal carcinoma,NPC)為發(fā)生于鼻咽部上皮及粘膜腺體的惡性腫瘤,在流行病學、組織病理學和解剖學方面有其獨特的表現(xiàn)。主要好發(fā)于我國南方、東南亞、中東和北非等地。放療是其最主要的治療方法。在早期予以單純放療即可獲得較為滿意的療效,5年生存率可達80%以上,但對無遠處轉(zhuǎn)移的局部晚期鼻咽癌而言,其療效卻不甚理想,出現(xiàn)遠處轉(zhuǎn)移者預后最差。近年來隨著調(diào)強放療及靶向治療藥物逐漸應(yīng)用于臨床,鼻咽部及頸部的局部控制率已有大幅度提高,患者放療后的生活質(zhì)量也有了明顯的改善。雖然局部晚期鼻咽癌的局部控制率和總生存率也有所提高,但5年生存率仍然較差,局部復發(fā)和遠處轉(zhuǎn)移是主要的失敗模式。目前,同期化放療在局部晚期鼻咽癌治療中已得到肯定,而誘導化療和輔助化療的作用仍存在較多爭議。如何減少遠處轉(zhuǎn)移、提高總生存率?如何優(yōu)化放化療結(jié)合模式,利用化療新藥來提高治療能效呢? 目的 觀察奈達鉑(Nedaplatin,NDP)和替加氟(Tegafur,FT-207)聯(lián)合化療方案在局部晚期鼻咽癌誘導化療中的近期療效和毒副反應(yīng);探討不同化療方案結(jié)合常規(guī)放射治療非遠處轉(zhuǎn)移鼻咽癌的療效及毒副反應(yīng);探討西妥昔單抗聯(lián)合化放療一線治療晚期鼻咽癌的有效性和安全性。 方法 采用回顧性分析方法,收集我科60例初治的局部晚期鼻咽癌病例,歸為改良PF方案組和常規(guī)PF方案組,每組30例,分別接受NDP+FT-207方案(NDP 30mg/m~2,d1-3;FT-207 600mg/m~2,d1-5;CF 0.2g,d1-5,每3周1次)和常規(guī)DDP+5-FU方案(DDP 30mg/m~2,d1-3;5-FU 500mg/m~2,d1-5;CF 0.2g,d1-5,每3周1次)誘導化療,2周期化療結(jié)束后行鼻咽部及頸部淋巴結(jié)常規(guī)放療,觀察各組的療效和毒副反應(yīng),并進行統(tǒng)計學比較。 回顧性分析157例非遠處轉(zhuǎn)移鼻咽癌患者,按與放療結(jié)合的不同方式分為單純放療組24例(單放組)、誘導化療組63例(誘導組)、輔助化療組31例(輔助組)、誘導化療+輔助化療組39例(誘導+輔助組),放射治療采用常規(guī)放射治療,比較各組患者的近期療效、生存情況、失敗模式、預后因素和毒副反應(yīng)。 對1例晚期鼻咽癌伴彌漫性肝轉(zhuǎn)移的患者予以3周期誘導化療+4周期同期化放療(鼻咽部加頸部淋巴結(jié)常規(guī)照射),在以上治療同步加用西妥昔單抗每周1次靜脈滴注,首劑400mg/m~2,以后每周250mg/m~2,共29周,觀察其療效及安全性。 結(jié)果 1.改良PF方案組CR率83.3%,PR率13.3%;常規(guī)PF方案組CR率70%,PR率30%,兩組比較差異無顯著性意義(P0.05)。改良PF方案組III-IV度粒細胞減少發(fā)生率為6.6%,常規(guī)PF方案組為3.3%,但兩組比較差異無顯著性意義(P0.05)。改良PF方案組III-IV級惡心、嘔吐發(fā)生率為6.7%,而常規(guī)PF方案組為26.7%,兩組比較差異有顯著性意義(P0.05)。 2.近期療效分析結(jié)果顯示,單純放療組、誘導化療組、輔助化療組、誘導化療+輔助化療組總有效率分別為95.8%、96.8%、96.7%和94.8%,差異無統(tǒng)計學意義(P=0.491);各組患者5年總生存率分別為56.4%、75%、62.9%和62.7% (P=0.845),無局部復發(fā)生存率分別為58%、66%、57%和69% ( P=0.734),無遠處轉(zhuǎn)移生存率分別為72%、73%、65%和71% (P=0.547)。T分期、N分期、臨床分期、頸動脈鞘區(qū)侵犯是影響患者的獨立預后因素。相關(guān)急性毒副反應(yīng)主要有骨髓抑制、胃腸道反應(yīng)和放射性皮膚黏膜炎。晚期副作用主要有口腔干燥癥、齲齒及牙齒脫落和頸部皮下組織纖維化。 3.通過常規(guī)放化療聯(lián)合西妥昔單抗治療,患者療效評估為完全緩解(CR),鼻咽部原發(fā)病灶和肝臟的轉(zhuǎn)移病灶均得到較好的控制。主要的副作用為:痤瘡樣皮疹、口腔黏膜反應(yīng)及骨髓功能抑制。 結(jié)論 1.奈達鉑聯(lián)合替加氟治療局部晚期鼻咽癌有較好療效,毒副反應(yīng)較輕,值得在鼻咽癌誘導化療中推廣應(yīng)用。 2.與單純放射治療相比,誘導化療、輔助化療以及兩者組合方案均未能顯著提高腫瘤無局部復發(fā)生存率、無遠處轉(zhuǎn)移生存率和總生存率,但在部分局部晚期鼻咽癌治療中有獲益趨勢。 3.西妥昔單抗聯(lián)合常規(guī)化放療治療晚期鼻咽癌效果滿意,毒副作用未顯著增加,值得臨床擴大樣本進一步證實。
[Abstract]:background Nasopharyngeal carcinoma (NPC) is a malignant tumor in the epithelial and mucosal glands of the nasopharynx. Performance. Mainly in the South, South-East Asia, Middle East and North Africa And so on. Radiotherapy is the most important treatment. The 5-year survival rate can reach more than 80%, but it is not ideal for locally advanced nasopharyngeal carcinoma with distant metastasis. In recent years, the local control rate of the nasopharynx and the neck has been greatly improved, and the quality of life after radiotherapy is also significant. The local control rate and overall survival rate of the local advanced nasopharyngeal carcinoma were improved, but the 5-year survival rate was still poor, local recurrence and distant metastasis were the main failure. Mode. At present, the concurrent radiotherapy has been confirmed in the treatment of locally advanced nasopharyngeal carcinoma, and the effect of induction chemotherapy and adjuvant chemotherapy still has more. Dispute. How to reduce the distance transfer and improve the overall life How to improve the survival rate? How to optimize the combination mode of radiotherapy and chemotherapy, and use the new drugs to improve the treatment performance The effect Objective To observe the recent curative effect and the side effect of Nedaplatin (NDP) and tegafur (FT-207) combined with chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Treatment of advanced nasopharyngeal carcinoma by the combination of cetuximab and radiotherapy in the treatment of advanced nasopharyngeal carcinoma to have The method used a retrospective analysis method to collect 60 cases of locally advanced nasopharyngeal carcinoma of the family, which was classified as an improved PF regimen group and a conventional PF regimen group. Each group received NDP + FT-207 regimen (NDP 30 mg/ m ~ 2, d1-3, FT-207 600 mg/ m ~ 2, d1, respectively). -5; CF 0.2 g, d1-5, once every 3 weeks) and conventional DDP + 5-FU regimen (DDP 30 mg/ m ~ 2, d1-3;5-FU 500 mg/ m ~ 2, d1-5; CF 0.2 g, d1-5, once every 3 weeks) induced chemotherapy, and the nasopharyngeal and cervical lymph nodes were treated with conventional radiotherapy at the end of 2-cycle chemotherapy to observe the efficacy of each group. A total of 157 patients with non-distant metastasis were analyzed retrospectively. Thirty-one (auxiliary group) of adjuvant chemotherapy group and 39 cases (induction + auxiliary group) of chemotherapy plus adjuvant chemotherapy group were induced by radiotherapy, and the recent curative effect and survival of the group were compared with the conventional radiotherapy. Case, failure mode, prognostic factors and side-to-side reaction. One patient with advanced nasopharyngeal carcinoma with diffuse liver metastasis was treated with 3-cycle induction chemotherapy plus 4-cycle concurrent radiotherapy (nasopharynx plus neck lymph node conventional irradiation), and the first dose of 400 mg/ m ~ 2.250 m every week g/ Results 1. The CR rate of the modified PF regimen was 83.3%, the PR rate was 13.3%, and the CR rate of the conventional PF regimen was 70%. The PR rate was 30%, and there was no significant difference between the two groups (P0.05). In the improved PF regimen, the incidence of nausea and vomiting was 6.7%, while the conventional PF regimen was not significant (P0.05). The results showed that the total effective rate of chemotherapy plus adjuvant chemotherapy group was 95.8%, 96.8%, 96.7% and 94.8%, respectively. The 5-year overall survival rate of each group was 56.4%,75%, 62.9% and 62.7% (P = 0.845), respectively. The survival rate of non-local recurrence was 58%,66%,57% and 69% (P = 0.734), and the survival rate of no distant metastasis was 72% and 73%, respectively. 65% and 71% (P = 0.547). T staging , N staging, clinical stage, and invasion of carotid artery and region are the independent prognostic factors that affect the patient. The response of the acute toxicity is mainly myelosuppression, gastrointestinal reaction, and mucositis of the radioactive skin. The side effects are mainly oral and dental caries, dental caries and tooth drop and neck subcutaneous tissue fibrosis.3. The efficacy of the patients is evaluated by the combination of conventional chemotherapy and chemotherapy with cetuximab. Complete response (CR), primary focus of the nasopharynx and metastatic focus of the liver were all obtained. -Okay.-Okay. Control. The main side effects were: skin rash, oral mucosa reaction and bone marrow function inhibition. In that treatment of locally advanced nasopharyngeal carcinoma, the treatment of the local advanced nasopharyngeal carcinoma has good curative effect, and the toxic side effect is light, and it is worth to be popularized and applied in the induction chemotherapy of the nasopharyngeal carcinoma.2. the induction chemotherapy, the adjuvant chemotherapy and the combination of the two combination can not significantly improve the tumor-free effect as compared with the simple radiation therapy. Local recurrence-free survival, no distant metastasis survival, and overall survival, but with a benefit trend in some locally advanced nasopharyngeal carcinoma treatment.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R739.63

【參考文獻】

相關(guān)期刊論文 前10條

1 張瑜;林志安;潘建基;鄭茁;楊凌;林少俊;鄭飛;;初治鼻咽癌調(diào)強放療與常規(guī)放療的同期對照研究[J];癌癥;2009年11期

2 韓露;林少俊;潘建基;陳傳本;張瑜;張秀春;廖希一;陳奇松;;305例鼻咽癌調(diào)強放療預后因素分析[J];癌癥;2010年02期

3 孔琳;張有望;胡超蘇;;新輔助化療聯(lián)合同期放化療治療局部晚期鼻咽癌的毒副反應(yīng)及近期療效(英文)[J];癌癥;2010年05期

4 Anne W.M.Lee;;Overview of clinical trials for nasopharyngeal carcinoma(in the English literature)[J];癌癥;2010年08期

5 劉通;馮麗麗;池桂玲;;健擇加順鉑聯(lián)合化療治療晚期鼻咽癌的療效觀察[J];河北醫(yī)學;2008年05期

6 龔曉昌;李金高;敖帆;袁霞;;同期放化療與單純放療治療局部晚期鼻咽癌的近期療效比較[J];江西醫(yī)藥;2005年11期

7 何小進;張英娣;趙印山;覃海波;楊輝;;奈達鉑和氟尿嘧啶同期放化療治療Ⅲ、Ⅳa期鼻咽癌[J];實用臨床醫(yī)學;2007年01期

8 高飛;賈霖;況小紅;李惠;王允;;單藥多西他賽聯(lián)合放療治療局部晚期鼻咽癌的臨床研究[J];四川醫(yī)學;2009年07期

9 潘險峰;唐曦;徐炎華;;奈達鉑聯(lián)合長春瑞濱結(jié)合同步放療治療晚期鼻咽癌的療效分析[J];現(xiàn)代生物醫(yī)學進展;2009年21期

10 ;1093例鼻咽癌療效和預后分析:21世紀初廣州單個中心的經(jīng)驗(英文)[J];Chinese-German Journal of Clinical Oncology;2008年04期

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