本文選題：鼻咽癌　切入點：時辰化療　出處：《貴州醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:觀察時辰化療聯(lián)合調強放療與常規(guī)化療聯(lián)合調強放療對局部晚期鼻咽癌患者生命質量和營養(yǎng)狀況的影響。預期時辰化療組較常規(guī)化療組更能降低患者化療帶來的不良反應,患者具有相對較高的生命質量和營養(yǎng)狀態(tài),為局部晚期鼻咽癌患者提供一種更合理的治療方式。方法:將85例鼻咽癌患者隨機分為試驗組(42例)和對照組(43例)。試驗組(時辰組)誘導化療及同步化療時在固定時間采用電子化療全自動注藥泵靜脈泵入給藥,TPF誘導化療:多西他賽 75mg/m2,03:30-04:30,靜脈滴注,d1;順鉑 75mg/m2,10:00-22:00,持續(xù)泵入,d1-5;5-氟尿嘧啶750mg/m2/d,22:00-10:00,持續(xù)泵入,d1-5;同步化療:單藥順鉑100mg/m2,10:00-22:00,持續(xù)泵入,d1,對照組(常規(guī)組)采用常規(guī)靜滴方式,TPF誘誘導化療:多西他賽75mg/m2,靜脈滴注,d1;順鉑75mg/m2,靜脈滴注,d1:5-氟尿嘧啶750mg/m2/d,持續(xù)泵入,d1-5;同步化療:單藥順鉑100mg/m2,靜脈滴注,d1)。同步放療均采用調強放射治療(IMRT),鼻咽原發(fā)灶劑量T1-2:PGTVnx DT=69.96Gy/33f,T3-4:PGTVnx DT=73.92Gy/33f,PTVnx DT=69.96Gy/33f,PGTVnd DT=69.96Gy/33f,PGTVrpn DT=69.96Gy/33f,PTV1 DT=60.06Gy/33f,PTV2 DT=50.96Gy/28f。運用癌癥患者生活質量測定量表EORTC QLQ-C30、頭頸腫瘤患者專用生活質量問卷表EORTC QLQ-HN35和營養(yǎng)狀況篩查表NRS-2002、患者主觀自評表PG-SGA觀察兩組不同給藥模式放化療前后患者生命質量和營養(yǎng)狀況的差別。采用SPSS 19.0統(tǒng)計分析軟件包進行數(shù)據(jù)錄入及統(tǒng)計分析。結果:①在治療前將兩組患者基線資料進行對比,兩組患者臨床特征差異無統(tǒng)計學意義(P0.05)。②在經過2周期誘導化療后時辰化療組患者總體健康狀況及降低消化道反應(惡心嘔吐、食欲喪失、便秘、吞咽困難、體重增加領域得分較常規(guī)組低)明顯好于常規(guī)化療組,差異有統(tǒng)計學意義(P0.05);時辰化療組患者在疲倦、失眠、疼痛、氣促等領域得分也低于常規(guī)化療組患者,但差異無統(tǒng)計學意義(P0.05)。在同步放化療治療結束時時辰化療組患者在社會功能、總健康狀況、降低惡心與嘔吐等領域明顯好于常規(guī)化療組,差異有統(tǒng)計學意義(P0.05)。③NRS2002調查顯示時辰化療組治療前、誘導化療后、同步放化療結束存在營養(yǎng)風險患者分別為2例、2例和36例;常規(guī)化療組分別為5例、7例和36例。PG-SGA評估可得出時辰化療組治療前、誘導化療后、同步放化療結束發(fā)生營養(yǎng)不良患者分別為15例、28例和42例;常規(guī)化療組分別為18例、31例和42例�；颊咴谥委熀蟀l(fā)生營養(yǎng)不良明顯增加,且常規(guī)組增加病例數(shù)多于時辰組。結論:時辰化療組與常規(guī)化療組相比能明顯減輕惡心嘔吐、食欲喪失、便秘等不良反應,使時辰化療組患者總體健康狀況及生命質量無明顯下降,較常規(guī)化療組好�；颊咴诮涍^治療后營養(yǎng)不良發(fā)生率增高。兩個生命質量問卷表及兩個營養(yǎng)風險篩查表易操作,可行性好,患者均可理解,并配合完成率高。局部晚期鼻咽癌患者采用時辰化療可能較常規(guī)化療成為一種更合理的治療模式。
[Abstract]:Objective: To observe the effect of chemotherapy combined with intensity modulated radiotherapy and conventional chemotherapy combined with radiotherapy for locally advanced nasopharyngeal cancer patients life quality and nutritional status. The expected Chrono chemotherapy group than the conventional chemotherapy group can reduce the adverse reaction of patients with chemotherapy, patients with relatively high quality of life and nutritional status, to provide a more reasonable the treatment for patients with locally advanced nasopharyngeal carcinoma. Methods: 85 cases of nasopharyngeal carcinoma patients were randomly divided into experimental group (42 cases) and control group (43 cases). The experimental group (Chrono group) by electronic automatic infusion pump intravenous chemotherapy pump infusion at a fixed time of induction chemotherapy and concurrent chemotherapy, induced by TPF 75mg/m2,03:30-04:30: docetaxel chemotherapy, intravenous infusion of cisplatin, D1; 75mg/m2,10:00-22:00, D1-5; 5- continuous infusion of fluorouracil, 750mg/m2/d, 22:00-10:00, continuous infusion, D1-5; chemotherapy: single drug cisplatin 100mg/m2,10 00-22:00, continuous infusion, D1, control group (routine group) with routine intravenous drip, TPF induced induction chemotherapy: Docetaxel 75mg/m2, intravenous infusion of cisplatin, D1; 75mg/m2, intravenous drip, d1:5- fluorouracil 750mg/m2/d, continuous infusion, D1-5; chemotherapy: single drug cisplatin 100mg/m2, intravenous drip, D1). Radiotherapy using intensity-modulated radiation therapy (IMRT), primary nasopharyngeal dose of T1-2:PGTVnx DT=69.96Gy/33f, T3-4:PGTVnx DT=73.92Gy/33f, PTVnx DT=69.96Gy/33f, PGTVnd DT=69.96Gy/33f, PGTVrpn DT=69.96Gy/33f, PTV1 DT=60.06Gy/ 33F, PTV2 DT=50.96Gy/28f. with cancer patients quality of life measuring scale EORTC QLQ-C30, patients with head and neck cancer specific quality of life questionnaire and EORTC QLQ-HN35 the nutritional status of patients with NRS-2002 screening, subjective self rating Anxiety Scale PG-SGA were observed in two groups of different administration modes before and after radiotherapy and chemotherapy patients life quality and nutritional status were different by SPS. S 19 statistical analysis software package for data entry and statistical analysis. Results: before the treatment the two groups of patients with baseline data were compared, no significant difference between the two groups (P0.05). The clinical features after 2 cycles of induction chemotherapy after the overall health of patients when chemotherapy and reduce gastrointestinal reactions (nausea and vomiting, loss of appetite, constipation, dysphagia, weight gain scores lower than the conventional group) was significantly better than the conventional chemotherapy group, the difference was statistically significant (P0.05); the Chrono chemotherapy group in patients with insomnia, fatigue, pain, shortness of breath, the field is lower than the score in the conventional chemotherapy group, but the difference was not statistically significant (P0.05). At the end of radiotherapy and chemotherapy in the treatment of patients with the Chrono chemotherapy group in social function, general health status, reduce nausea and vomiting and other fields are significantly better than the conventional chemotherapy group, the difference was statistically significant (P0.05). The NRS2002 survey Show the Chrono chemotherapy group before treatment, after induction chemotherapy, radiotherapy and chemotherapy are the end of nutritional risk patients were 2 cases, 2 cases and 36 cases; conventional chemotherapy group were 5 cases, 7 cases and 36 cases of.PG-SGA can be obtained to evaluate the Chrono chemotherapy group before treatment, after induction chemotherapy, radiotherapy and chemotherapy end of nutrients patients were 15 cases, 28 cases and 42 cases; conventional chemotherapy group were 18 cases, 31 cases and 42 cases. Patients in the treatment after the incidence of malnutrition increased significantly, and increase the number of cases than the conventional group hour group. Conclusion: Chrono chemotherapy group compared with the conventional chemotherapy group can significantly reduce nausea and vomiting. Loss of appetite, constipation and other adverse reactions, the Chrono chemotherapy group patients overall health and quality of life decreased significantly, compared with the conventional chemotherapy group. The patients after treatment for malnutrition rate increased two. The quality of life questionnaire and two nutritional risk screening table easily The operation is feasible, and the patients can understand and cooperate with the completion rate. The local advanced nasopharyngeal carcinoma patients with chronopharyngeal chemotherapy may become a more reasonable treatment mode than conventional chemotherapy.

【學位授予單位】：貴州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.63

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