中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (8): 602-608.doi: 10.19401/j.cnki.1007-3639.2018.08.007

• 论著 • 上一篇    下一篇

GP、PF及TPF方案化疗联合调强适形放疗治疗鼻咽癌的临床疗效

杨佑琦,区晓敏,周 鑫,史 琪,邢 星,胡超苏   

  1. 复旦大学附属肿瘤医院放疗科,复旦大学上海医学院肿瘤学系,上海 200032
  • 出版日期:2018-08-30 发布日期:2018-09-14
  • 通信作者: 胡超苏 E-mail:hucsu62@163.com

Clinical efficacy of GP, PF and TPF chemotherapy combined with intensity-modulated radiotherapy for nasopharyngeal carcinoma

YANG Youqi, OU Xiaomin, ZHOU Xin, SHI Qi, XING Xing, HU Chaosu   

  1. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
  • Published:2018-08-30 Online:2018-09-14
  • Contact: HU Chaosu E-mail: hucsu62@163.com

摘要: 背景与目的:诱导化疗联合放疗及辅助化疗治疗鼻咽癌的疗效目前尚未明确,本研究旨在比较GP(吉西他滨+顺铂)方案、PF(顺铂+氟尿嘧啶)方案及TPF(多西他赛+顺铂+氟尿嘧啶)方案化疗联合调强适形放疗(intensity-modulated radiotherapy,IMRT)在无远处转移鼻咽癌患者中的临床疗效。方法:本研究回顾性分析了2009年1月—2010年12月期间在复旦大学附属肿瘤医院放疗科接受诱导化疗联合IMRT及辅助化疗的134例无远处转移鼻咽癌患者。GP组(吉西他滨1 000 mg/m2,第1、8天+顺铂25 mg/m2,第1~3天)、PF组(顺铂25 mg/m2,第1~3天+氟尿嘧啶500 mg/m2,第1~5天,持续静脉滴注)及TPF组(多西他赛75 mg/m2,第1天+顺铂25 mg/m2,第1~3天+氟尿嘧啶500 mg/m2,第1~5天,持续静脉滴注)分别纳入55、20和59例患者。诱导化疗每21 d重复,2~3个疗程后行IMRT。原发灶及阳性淋巴结的大体肿瘤靶区(gross tumor volume,GTV)的处方剂量分别为(66.0~70.4)Gy/(30~32)次和66.0 Gy/(30~32)次。放疗结束28 d后行辅助化疗2~3个疗程,方案与之前接受的诱导化疗方案相同。随访并比较3组不同的诱导化疗联合放疗及辅助化疗方案的患者5年总生存期(overall survival,OS)、无病生存期(disease-free survival,DFS)及局部无复发生存期(local recurrence-free survival, LRFS)情况。结果:GP组、PF组和TPF组的5年OS率分别为91.9%、75.1%和90.8%,5年LRFS率分别为95.8%、82.3%和96%。GP组的5年OS率(P=0.041)高于PF组,TPF组的5年LRFS率高于PF组(P=0.043)。TPF组和GP组间生存曲线差异无统计学意义。结论:GP方案诱导化疗联合IMRT及辅助化疗治疗无远处转移鼻咽癌的临床疗效可能优于PF方案,尚待大样本数据验证。三药联合的TPF方案并未优于GP方案。可考虑展开Ⅲ期临床试验评价GP方案诱导化疗在无远处转移初治鼻咽癌人群中的疗效。

关键词: 鼻咽癌, 诱导化疗, 调强放疗, 辅助化疗, 临床疗效

Abstract: Background and purpose: The efficacy of induction chemotherapy (IC) combined with intensitymodulated radiotherapy (IMRT) and adjuvant chemotherapy (AC) for nasopharyngeal carcinoma (NPC) remains unclear. This study aimed to compare the clinical outcomes of GP (gemcitabine plus cisplatin) regimen, PF (cisplatin and 5-FU) regimen and TPF (docetaxel, cisplatin and 5-FU) regimen combined with IMRT in patients with nonmetastatic NPC. Methods: This study retrospectively analyzed 134 patients with non-metastatic NPC who received IC combined with IMRT and AC in Department of Radiation Oncology, Fudan University Shanghai Cancer Center from Jan. 2009 to Dec. 2010. Group GP (gemcitabine 1 000 mg/m2 on day 1 and 8, and cisplatin 25 mg/m2 on days 1-3), group PF (cisplatin 25mg/m2 on days 1-3, and 5-FU 500 mg/m2 on days 1-5 with continuous infusion) and TPF group (docetaxel 75 mg/m2 on day 1, cisplatin 25 mg/m2 on day 1-3, and 5-FU 500 mg/m2 on days 1-5 with continuous infusion) enrolled 55, 20 and 59 patients, respectively. IMRT was delivered after 2-3 cycles of IC with a 21-day interval. The prescribed doses of gross tumor volume (GTV) for primary tumor and positive lymph nodes were (66.0-70.4) Gy/(30-32) F and 66.0 Gy/(30-32) F, respectively. Two to three cycles of AC were administered 28 days after completion of radiotherapy with the same regimen as IC. The 5-year overall survival (OS), disease-free survival (DFS) and local recurrence-free survival (LRFS) rates in the three groups were evaluated. Results: The 5-year OS rates of group GP, group PF and group TPF were 91.9%, 75.1% and 90.8%, respectively. The 5-year LRFS rates were 95.8%, 82.3%, and 96%, respectively. The 5-year OS (P=0.041) in group GP was higher than that in PF group. The 5-year LRFS rate in group TPF was higher than that in group PF (P=0.043). There was no significant difference in survival curves between group TPF and group GP. Conclusion: The clinical efficacy of GP regimen combined with IMRT and AC for the treatment of non-metastatic nasopharyngeal carcinoma may be better than that of PF regimen, and verification of large sample data is needed. The three drugs combined TPF regimen is not superior to the GP scheme. Phase Ⅲ clinical trial to evaluate the efficacy of GP regimen in patients with non-metastatic nasopharyngeal carcinoma could be considered.

Key words: Nasopharyngeal carcinoma, Induction chemotherapy, Intensity-modulated radiotherapy, Adjuvant chemotherapy, Clinical efficacy