诱导化疗联合洛铂同期放化疗治疗局部晚期头颈部鳞癌临床研究

Clinical Studies on Induction Chemotherapy Followed by Concurrent Lobaplatin Chemoradiotherapy for Locally Advanced Head and Neck Squamous Cell Carcinoma

摘要: 目的：研究诱导化疗联合洛铂同期放化疗治疗局部晚期头颈部鳞癌的毒副反应及疗效。方法：16例经病理证实头颈部局部晚期鳞状细胞癌患者，采用TPF方案(多西他赛 + 顺铂 + 氟尿嘧啶)诱导化疗2周期，21天/周期。2周期诱导化疗结束后3周开始行同期放化疗，放疗采用调强放射治疗，剂量为95% PGTVp 69.96 Gy/33f，95% PGTVnd 69.96 Gy/33f，90% PTV1 60.06 Gy/33f，90% PTV2 50.96 Gy/28f，同期化疗：洛铂50 mg/m2 d1，21天/周期，共两周期。放化疗结束1个月后行辅助化疗：方案及方法同诱导化疗，共2周期。结果：诱导化疗后的有效率：81%，CR率6%、PR率为75%、NC率为19%、PD率0%。同期放化疗结束后有效率：94%，CR率38%、PR率为56%、NC率为6%、PD率0%。1年总生存率92%。诱导化疗的主要毒副反应：3~4级血小板降低1例，3~4级白细胞降低6例，3~4级中性粒细胞降低5例；同期放化疗的主要毒副反应，3~4级口腔黏膜炎4例，3~4级血小板降低11例，3~4级白细胞降低7例，3~4级中性粒细胞降低5例，消化道反应表现为1~2级，1级谷丙转氨酶升高2例。结论：1) 诱导化疗联合同期洛铂放化疗毒副反应主要是血小板降低，但经积极处理后可顺利完成治疗，其他不良反应如消化系统、肝、肾毒性、耳毒性反应较轻。2) 诱导化疗联合同期洛铂放化疗的近期疗效较好，但仍需大宗病例进一步研究。

Abstract: Objective: To investigate the efficacy and the adverse effects in locally advanced squamous cell carcinoma of the head and neck treated with the induction chemotherapy (ICT), followed by intensity- modulated radiotherapy (IMRT) and concurrent chemo therapy (CCC). Methods: Chose 16 stages III - IV head and neck squamous cell carcinoma patients with no distant metastases who were enrolled in this study. All people were treated with a protocol of ICT 2 cycles (21 days/cycle) with Docetaxel, Cisplatin and Fluorouracil (TPF). After 2 cycles of induction chemotherapy, it began the concurrent chemoradiotherapy in the third week with the dose of 95% PGTVp 69.96 Gy/33f, 95% PGTVnd 69.96 Gy/33f, 90% PTV1 60.06 Gy/33f, 90% PTV2 50.96 Gy/28f. Concurrent chemotherapy was 50 mg/m2 Lobaplatin d1, 21 days/cycle and a total of two cycles. Additionally, a month after the chemotherapy, an adjuvant chemotherapy, with the same scheme as that of induction chemotherapy curative effect of induction chemotherapy was 81%, with CR 6%, PR 75%, NC 19% and PD 0%. The overall response rate was 94%, with CR 38%, PR 56 %, NC 6% and PD 0%. Additionally, a month after the chemotherapy, an adjuvant chemotherapy had the same scheme as that of induction chemotherapy. Results: The overall response rate was 94%. The 12 months overall survival rate was 92%. The main side effects from induction chemotherapy were thrombopenia with 1 case, leukopenia with 6 cases, neutropenia with 5 cases in grade 3 to 4. The main side effects from concurrent lobaplatin chemoradio therapy were oral mucositis with 4 cases, thrombopenia with 11 cases, leukopenia with 7 cases, neutropenia with 5 cases in grade 3 to 4. The reactions of alimentary tract were relatively reduced. The grade glutamic-pyruvic transaminase was 2 cases slightly higher. Conclusions: 1) The main side effect from concurrent lobaplatin chemoradiotherapy was thrombopenia. Other side effects: digestive system and renal ears toxicity were soft. 2) The recent efficacy of the linduction chemotherapy followed by Con- current lobaplatin chemoradiotherapy was good, and the exact efficacy and side effects still needed further research to expand the number of cases.