奈达铂联合调强放疗对局部晚期鼻咽癌的疗效的作用分析
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摘要
目的:分析奈达铂联合强调放疗在局部晚期鼻咽癌患者中的疗效。方法:选择我院局部晚期鼻咽癌患者87例,随机分为两个组,分别是奈达铂组(A组)和顺铂组(B组),对两组患者接受治疗后的近期疗效、远期疗效以及毒性反应进行比较分析。结果:A、B两组患者鼻咽原发灶完全缓解(CR)率分别为91.8%、86.8%(P=0.632>0.05),颈部淋巴结转移灶的完全缓解(CR)率分别为87.8%、84.2%(P=0.864>0.05),均不存在统计学显著性差异。A、B两组患者3年的总生存率(OS)分别为:81.6%、78.9%,P=0.762;局部控制率(LC)分别为:93.9%、94.7%,P=0.890;两组患者3年的区域控制率(RC)分别为:98.0%、97.3%,P=0.849;两组患者3年的无远处转移生存率(DMFS)分别为:79.6%、76.3%,P=0.724。A组患者Plt下降发生率为46.9%显著高于B组发生率34.2%(P<0.05),具有统计学显著性差异;A组患者恶心呕吐的发生率36.7%显著低于B组患者的发生率76.3%(P<0.05),具有统计学显著性差异;其余毒性反应的发生率均不存在统计学显著性差异(P>0.05)。结论:奈达铂联合强调放疗治疗局部晚期鼻咽癌的近期疗效与远期疗效与顺铂相当,但是奈达铂胃肠道不良反应发生率较顺铂低,血小板的降低程度比顺铂更加严重。
Objective: To analyze the medical effect of intensified radiotherapy combined with nedaplatin on patients with locally advanced nasopharyngeal cancer. Methods: 87 cases with locally advanced nasopharyngeal cancer who were treated in our hospital were selected and randomly divided into two groups. Then the short term curative effect, long term curative effect, and toxic reactions of the patients in the two groups were observed and compared between two groups after treatment. Results: The Complete Re- mission(CR) rates of the nasopharyngeal primary lesion in the patients of Group A and B are respectively 91.8%, 86.8%(p=0.632>0.05); The Complete Remission(CR) rates of the metastases in the patients' cervical lymph nodes are respectively 87.8%, 4.2%(p= 0.864>0.05). All the rates indicate no evidently statistical difference. The Overall Survival(OS) rates within three years of the patients in Group A and Group B are respectively 81.6%, 78.9%, P=0.762; Local Controlling(LC) rates are respectively 93.9%, 94.7%, P=0.890. The Regional Controlling(RC) rates are respectively 98.0%, 97.3% P=0.849. Distance Metastasis Free Survival(DMFS) rates are respectively 79.6%, 76.3%, P=0.724. The Plt reduction rate of Group A is 46.9%, obviously higher than 34.2%, the reduction rate of Group B(P<0.05), which has great statistical difference. Occurrence rate of nausea and vomiting in Group A is 36.7%, obviously lower than 76.3%, the occurrence rate of nausea and vomiting in Group B(P<0.05), which has great statistical difference; the occurrence rates of toxic reaction have no big statistical difference(P>0.05). Conclusion: Nedaplatin combined with radiotherapy for locally advanced nasopharyngeal emphasize short-term efficacy and long-term efficacy with cisplatin quite, but nedaplatin incidence of gastrointestinal adverse reactions compared with cisplatin low platelet levels decreased more than cisplatin severe.
Objective: To analyze the medical effect of intensified radiotherapy combined with nedaplatin on patients with locally advanced nasopharyngeal cancer. Methods: 87 cases with locally advanced nasopharyngeal cancer who were treated in our hospital were selected and randomly divided into two groups. Then the short term curative effect, long term curative effect, and toxic reactions of the patients in the two groups were observed and compared between two groups after treatment. Results: The Complete Re- mission(CR) rates of the nasopharyngeal primary lesion in the patients of Group A and B are respectively 91.8%, 86.8%(p=0.632>0.05); The Complete Remission(CR) rates of the metastases in the patients' cervical lymph nodes are respectively 87.8%, 4.2%(p= 0.864>0.05). All the rates indicate no evidently statistical difference. The Overall Survival(OS) rates within three years of the patients in Group A and Group B are respectively 81.6%, 78.9%, P=0.762; Local Controlling(LC) rates are respectively 93.9%, 94.7%, P=0.890. The Regional Controlling(RC) rates are respectively 98.0%, 97.3% P=0.849. Distance Metastasis Free Survival(DMFS) rates are respectively 79.6%, 76.3%, P=0.724. The Plt reduction rate of Group A is 46.9%, obviously higher than 34.2%, the reduction rate of Group B(P<0.05), which has great statistical difference. Occurrence rate of nausea and vomiting in Group A is 36.7%, obviously lower than 76.3%, the occurrence rate of nausea and vomiting in Group B(P<0.05), which has great statistical difference; the occurrence rates of toxic reaction have no big statistical difference(P>0.05). Conclusion: Nedaplatin combined with radiotherapy for locally advanced nasopharyngeal emphasize short-term efficacy and long-term efficacy with cisplatin quite, but nedaplatin incidence of gastrointestinal adverse reactions compared with cisplatin low platelet levels decreased more than cisplatin severe.
引文
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[9]潘险峰,唐曦,徐炎华.奈达铂联合长春瑞滨结合同步放疗治疗晚期鼻咽癌的疗效分析[J].现代生物医学进展,2009,9(21):4085-4087Pan Xian-feng,Tang Xi,Yu Yan-hua.Clinical observation of Nedaplatin and Vinorelbine chemotherapy combined with radiotherapy in the treatment of advanced Nasopharyngeal Carcinoma[J].Progress in Modern Biomedicine,2009,9(21):4085-4087
[10]殷蔚伯,谷铣之.肿瘤放射治疗学[M].北京:中国协和医科大学出版社,2008:443-484Yin Wei-bo,Gu Xian-zhi.Radiation oncology(4E)[M].Beijin Chinese HarmonyMedical College Publishing House,2008:443-484
[11]彭杰文,梁汉霖,张俊凯,等.奈达铂治疗晚期头颈癌的临床疗效观察[J].中华肿瘤防治杂志,2007,14(10):779-781Peng Jie-wen,Liang Han-ling,Zhang Jun-kai,et al.Clinical effect of nedaplatin in treatment of advanced head and neck cancer[J].Chinese Journal of Cancer Pervention and Treatment,2007,14(10):779-781
[12]Nancy Lee,Jonathan Harris,Adam S Garden,et al.Intensity-Modulated Radiation Therapy With or Without Chemotherapy for Nasopharyngeal Carcinoma:Radiation Therapy Oncology Group Phase II Trial0225[J].Journal of Clinical Oncology,2009,27(22):3684-3690
[13]Anne WM Lee,Stewart Y Tung,Daniel TT Chua,et al.Randomized Trial of Radiotherapy Plus Concurrent-Adjuvant Chemotherapy vs Radiotherapy Alone for Regionally Advanced Nasopharyngeal Carcinoma[J].JNCI Journal of the National Cancer Institute,2010,102(15):1188-1198
[14]陶华,陆进成,李枫.局部晚期鼻咽癌同步化疗与诱导化疗联合调强放疗的疗效分析[J].中国现代医药杂志,2011,13(6):13-16Tao Hua,Lu Jin-cheng,Li Feng.Outcome of clinical study of comparing chemotherapy neoadjuvant or concurrently with intensity-modulated radiotherapy for local advanced nasopharyngeal carcinoma[J].MMJC,2011,13(6):13-16
[15]Citrin D,Mansueti J,Likhacheva A,et al.Long-term outcomes and toxicity of concurrent paclitaxel and radiotherapy for locally advanced head-and-neck cancer[J].Int J Radiat Oncol Biol Phys,2009,74:1040-1046
[16]Xia Yun-he,Chao Su-hu,Hong Mei-ying,et al.Paclitaxel with cisplatin in concurrent chemoradiotherapy for locally and advanced nasopharyngeal carcinoma[J].Eur Arch Otorhinolaryngol,2010,267:773-778
[17]Agarwala SS,Cano E,Heron DE,et al.Long-term outcomes with concurrent carboplatin,paclitaxel and radiation therapy for locally advanced,inoperable head and neck cancer[J].Ann Oncol,2007,18:1224-1229
[18]胡福军,陈晓钟,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):917-920Hu Fu-jun,Chen Xiao-zhong,Jiang Feng,et al.Clinical study of 135locally advanced nasopharyngeal carcinoma patients for intensity modulated radiation therapy and chemotherapy[J].Chin J Cancer Prev Treat,2012,19(12):917-920
[19]林连兴,许鸿鹞,徐志渊.单药奈达铂同期放化疗治疗局部晚期鼻咽癌的临床观察[J].中国医院用药评价与分析,2012,12(4):346-350Lin Lian-xing,Xu Hong-yao,Xu Zhi-yuan.Nedaplatin Plus Concurrent Radiotherapy for Locally Advanced Nasopharyngeal Carcinoma[J].Evaluation and analysis of drug-use in hospitals of China,2012,12(4):346-350
[20]Lee AWM,Tung SY,Chan ATC,et al.Preliminary results of a randomized study(NPC-9902 trial)on therapeutic gain by concurrent chemotherapy and/or accelerated fractionation for locally advanced nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2006,66(1):142
[21]周翡,罗金红,王理伟.奈达铂联合放疗治疗晚期鼻咽癌[J].中国癌症杂志,2012,17(6):490-492Zhou Fei,Lu Jin-hong,Wang Li-wei.Nedapla tin combined with radiotherapy in the treatment of advanced nasopharyngeal carcinoma[J].China Oncology,2012,17(6):490-492
[2]Wilko FAR,Johan P,Daan Hoffmans,et al.Volumetric IntensityModulated Arc Therapy Vs Conventional IMRT in Head-and-Neck Cancer:A Comparative Planning and Dosimetric Study[J].International Journal of Radiation Oncology Biology Physics,2009,74(1):252-259
[3]Lee NY,Le QT.New developments in radiation therapy for head and neck cancer:intensity-modulated radiation therapy and hypoxia targeting[J].Semin Oncol,2008,35:236-250
[4]何阳科,张幸平.局部晚期鼻咽癌的综合治疗进展[J].现代生物医学进展,2012,12(5):972-974,1000He Yang-ke,Zhang xing-ping.Progress of Combined Modality Therapy in Locally Advanced Nasopharyngeal Carcinoma[J].Progress in Modern Biomedicine,2012,12(5):972-974,1000
[5]Dennis ER,Bussiere MR,Niemierko A,et al.A comparison of critical structure dose and toxicity risks in patients with low grade gliomas treated with IMRT versus proton radiation therapy[J].Technol Cancer Res Treat,2013,12(1):1-9
[6]Vesna Jacob,Wolfgang Bayer,Sabrina T.Astner,et al.A Planning Comparison of Dynamic IMRT for Different Collimator Leaf Thicknesses with Helical Tomotherapy and RapidArc for Prostate and Head and Neck Tumors[J].Strahlentherapie und Onkologie,2010,186(9):501-510
[7]陈绍俊,黄海欣,黄东宁,等.奈达铂或顺铂联合调强放疗治疗局部晚期鼻咽癌的疗效[J].江苏医药,2013,39(8):931-934Chen Shao-jun,Huang Hai-Xin,Huang Dong-ning,et al.Clinical efficacy nedaplatin or cisplatin combined with intensity-modulated radiation therapy in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma[J].Jiangsu Med,2013,39(8):931-934
[8]Ng WT,Lee MC,Hung WM,et al.Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2011,79:420-428
[9]潘险峰,唐曦,徐炎华.奈达铂联合长春瑞滨结合同步放疗治疗晚期鼻咽癌的疗效分析[J].现代生物医学进展,2009,9(21):4085-4087Pan Xian-feng,Tang Xi,Yu Yan-hua.Clinical observation of Nedaplatin and Vinorelbine chemotherapy combined with radiotherapy in the treatment of advanced Nasopharyngeal Carcinoma[J].Progress in Modern Biomedicine,2009,9(21):4085-4087
[10]殷蔚伯,谷铣之.肿瘤放射治疗学[M].北京:中国协和医科大学出版社,2008:443-484Yin Wei-bo,Gu Xian-zhi.Radiation oncology(4E)[M].Beijin Chinese HarmonyMedical College Publishing House,2008:443-484
[11]彭杰文,梁汉霖,张俊凯,等.奈达铂治疗晚期头颈癌的临床疗效观察[J].中华肿瘤防治杂志,2007,14(10):779-781Peng Jie-wen,Liang Han-ling,Zhang Jun-kai,et al.Clinical effect of nedaplatin in treatment of advanced head and neck cancer[J].Chinese Journal of Cancer Pervention and Treatment,2007,14(10):779-781
[12]Nancy Lee,Jonathan Harris,Adam S Garden,et al.Intensity-Modulated Radiation Therapy With or Without Chemotherapy for Nasopharyngeal Carcinoma:Radiation Therapy Oncology Group Phase II Trial0225[J].Journal of Clinical Oncology,2009,27(22):3684-3690
[13]Anne WM Lee,Stewart Y Tung,Daniel TT Chua,et al.Randomized Trial of Radiotherapy Plus Concurrent-Adjuvant Chemotherapy vs Radiotherapy Alone for Regionally Advanced Nasopharyngeal Carcinoma[J].JNCI Journal of the National Cancer Institute,2010,102(15):1188-1198
[14]陶华,陆进成,李枫.局部晚期鼻咽癌同步化疗与诱导化疗联合调强放疗的疗效分析[J].中国现代医药杂志,2011,13(6):13-16Tao Hua,Lu Jin-cheng,Li Feng.Outcome of clinical study of comparing chemotherapy neoadjuvant or concurrently with intensity-modulated radiotherapy for local advanced nasopharyngeal carcinoma[J].MMJC,2011,13(6):13-16
[15]Citrin D,Mansueti J,Likhacheva A,et al.Long-term outcomes and toxicity of concurrent paclitaxel and radiotherapy for locally advanced head-and-neck cancer[J].Int J Radiat Oncol Biol Phys,2009,74:1040-1046
[16]Xia Yun-he,Chao Su-hu,Hong Mei-ying,et al.Paclitaxel with cisplatin in concurrent chemoradiotherapy for locally and advanced nasopharyngeal carcinoma[J].Eur Arch Otorhinolaryngol,2010,267:773-778
[17]Agarwala SS,Cano E,Heron DE,et al.Long-term outcomes with concurrent carboplatin,paclitaxel and radiation therapy for locally advanced,inoperable head and neck cancer[J].Ann Oncol,2007,18:1224-1229
[18]胡福军,陈晓钟,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):917-920Hu Fu-jun,Chen Xiao-zhong,Jiang Feng,et al.Clinical study of 135locally advanced nasopharyngeal carcinoma patients for intensity modulated radiation therapy and chemotherapy[J].Chin J Cancer Prev Treat,2012,19(12):917-920
[19]林连兴,许鸿鹞,徐志渊.单药奈达铂同期放化疗治疗局部晚期鼻咽癌的临床观察[J].中国医院用药评价与分析,2012,12(4):346-350Lin Lian-xing,Xu Hong-yao,Xu Zhi-yuan.Nedaplatin Plus Concurrent Radiotherapy for Locally Advanced Nasopharyngeal Carcinoma[J].Evaluation and analysis of drug-use in hospitals of China,2012,12(4):346-350
[20]Lee AWM,Tung SY,Chan ATC,et al.Preliminary results of a randomized study(NPC-9902 trial)on therapeutic gain by concurrent chemotherapy and/or accelerated fractionation for locally advanced nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2006,66(1):142
[21]周翡,罗金红,王理伟.奈达铂联合放疗治疗晚期鼻咽癌[J].中国癌症杂志,2012,17(6):490-492Zhou Fei,Lu Jin-hong,Wang Li-wei.Nedapla tin combined with radiotherapy in the treatment of advanced nasopharyngeal carcinoma[J].China Oncology,2012,17(6):490-492
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