本文選題：鼻咽癌 + 時(shí)辰化療��； 參考：《貴州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:比較時(shí)辰化療與常規(guī)化療聯(lián)合調(diào)強(qiáng)放療在局部晚期鼻咽癌患者治療過(guò)程中的毒副反應(yīng)、免疫功能、即刻療效,期望在不降低臨床療效的基礎(chǔ)上,能減少治療相關(guān)毒副反應(yīng)的發(fā)生、降低免疫功能的損傷,為傳統(tǒng)的化療藥物找到一種新的應(yīng)用模式。方法:將114例初治局部晚期鼻咽癌患者隨機(jī)分為兩組,時(shí)辰化療組(chronomodulated chemotherapy with radiotherapy,CCR)患者(57例)多西他賽(DOC):75mg/m2,ivgtt,d1(03:30～04::30);順鉑(DDP):75mg/m2,civ,d1-d5(10:00-22:00);5-氟尿嘧啶(5-FU):750mg/m2/d1,泵內(nèi)注入,d1-d5(22:00～10:00)。同步化療:DDP100mg/m2,civ,d1(10:00～22:00);常規(guī)化療組(routine-chemotherapy with radiotherapy,RCR)患者(57例)DOC:75mg/m2,ivgtt,d1;DDP:75mg/m2,ivgtt,第 1 天;5-FU:750mg/m2/d1,civ,d1-d5(持續(xù)泵入120小時(shí))。同期化療:DDP100mg/m2,ivgtt,d1。兩組放療均采用調(diào)強(qiáng)放射治療,6MV-X,劑量:T1-2GTVnx 69.96 Gy/33f;T3-4 GTVnx 73.92Gy/33f,PTVnx 69.96Gy/33f,PGTVnd 69.96Gy/33f,PTV1 60.06Gy/33f,PTV2 50.96Gy/28f,1f/d,5f/w。即刻療效評(píng)價(jià)采用Recisit 1.1 標(biāo)準(zhǔn)評(píng)價(jià),CTC 3.0評(píng)價(jià)不良反應(yīng)。用PASW statistics 22.0軟件錄入數(shù)據(jù)并進(jìn)行結(jié)果分析。結(jié)果:時(shí)辰化療組與常規(guī)化療組的即刻療效評(píng)價(jià)CR、PR、SD、PD差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),兩組有效率(CR+PR)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);時(shí)辰化療組的白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞計(jì)數(shù)、嘔吐、口腔黏膜炎發(fā)生率顯著低于常規(guī)化療組(P0.05);時(shí)辰化療組CD3+、CD4+/8+T細(xì)胞計(jì)數(shù)顯著高于常規(guī)化療組(P0.05)。結(jié)論:時(shí)辰化療作為一種新的治療模式,與調(diào)強(qiáng)放療聯(lián)合可在不降低臨床療效的同時(shí)減輕治療相關(guān)副反應(yīng)的發(fā)生率及嚴(yán)重程度,可改善免疫功能,值得臨床推廣及應(yīng)用。
[Abstract]:Objective: to compare the toxic side effects, immune function, immediate effect of time chemotherapy and conventional chemotherapy combined with intensity modulated radiotherapy in the treatment of local advanced nasopharyngeal carcinoma patients. It can reduce the occurrence of toxic side effects and decrease the damage of immune function, and find a new application mode for traditional chemotherapeutic drugs. Methods: one hundred and forty four patients with locally advanced nasopharyngeal carcinoma were randomly divided into two groups: chemotherapy group (n = 57): docetaxel (n = 57) docetaxel (n = 75 mg / m ~ (2) ivgttd1010: 30: 30: 30; cisplatin DDP /% (75 mg / m ~ (2): civd1-d5 / 10: 00-22005-fluorouracil (5-FU) / 750mg / m ~ (2) / d ~ (-1). Synchronous chemotherapy: DDP 100 mg / m2civd1 10: 00 00: 00; routine chemotherapy group: routine-chemotherapy with radiotherapyr; 57 cases with DOC: 75mg / m2ivgtd1d1 DDP: 75mg / m2ivgtt. the first day 5-FU: 750mgm2d2civd1-d5 (continuously pumped 120 hours). Chemotherapy: DDP 100 mg / m 2 iv d 1. Both groups were treated with IMV X at the dose of: T1-2GTVnx 69.96Gy / 33fN T3-4 GTVnx 73.92Gy / 33fnx PGTVnd 69.96Gy / 33fPTV1 60.06Gy / 33fPTV250.96Gy / 28fdT / 5frw. The immediate efficacy was evaluated by Recisit 1.1 standard and CTC3.0 was used to evaluate adverse reactions. Input data with PASW statistics 22. 0 software and analyze the results. Results: there was no significant difference in the immediate curative effect between the two groups (P 0.05), but there was no significant difference in the effective rate between the two groups (P 0.05), while the leukocyte count, neutrophil count, vomiting in the hour chemotherapy group were not significantly different from those in the control group. The incidence of oral mucositis was significantly lower than that of routine chemotherapy group (P 0.05), and the CD3 CD4 / 8 T cell count in chemotherapy group was significantly higher than that in routine chemotherapy group (P 0.05). Conclusion: as a new treatment mode, time chemotherapy combined with intensity modulated radiotherapy can reduce the incidence and severity of side effects while not reducing the clinical efficacy. It can improve immune function and is worthy of clinical popularization and application.
【學(xué)位授予單位】：貴州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.63

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