调强治疗年代下局部晚期鼻咽癌诱导化疗方案分析

doi:10.3969/j.issn.2095-1264.2024.05.08

首页 > 过刊浏览>2024年第5期 >569-575. DOI:10.3969/j.issn.2095-1264.2024.05.08

调强治疗年代下局部晚期鼻咽癌诱导化疗方案分析
DOI:
                        10.3969/j.issn.2095-1264.2024.05.08
                    
作者:
                        
                        
                    
作者单位:湖南省肿瘤医院/中南大学湘雅医学院附属肿瘤医院，湖南 长沙，410013
作者简介:罗希，女，博士，医师，研究方向为头颈部肿瘤的综合治疗。
通讯作者:韩亚骞，男，硕士，主任医师，研究方向为头颈部肿瘤的放射治疗及综合治疗。
中图分类号:R739.6
基金项目:湖南省自然科学基金项目（2024JJ6294、2024JJ8209）；湖南省卫生健康委卫生科研课题（W20243006、20230473、20230076、W20243082）； 湖南省鼻咽癌精准治疗临床医学研究中心（2023SK4034）；湖南省肿瘤医院科研攀登计划（2023NSFC-B003）。

Induction chemotherapy regimens analysis of locally advanced nasopharyngeal carcinoma in the era of intensity-modulated therapy

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Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China

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摘要:

目的分析真实世界中诱导化疗联合以调强放疗为基础的放疗/同期放化疗对局部晚期鼻咽癌的疗效。方法回顾性分析2018年1月—2019年1月在湖南省肿瘤医院接受诱导化疗联合根治性放疗/同期放化疗的821例初治局部晚期鼻咽癌患者资料。所有患者均接受根治剂量的放疗/同期放化疗，诱导化疗方案包括TP、TPF、GP或PF方案，比较不同方案的疗效和毒性反应。结果中位随访时间为61.3（IQR 57.3~64.8）个月。PSM配对后，TP组、TPF组和PF组5 年总生存（OS）率分别为85.8%、79.6%和81.6%（P=0.222），无局部区域复发生存（LRRFS）率分别为93.1%、89.6%和91.9%（P=0.515），无远处转移生存（DMFS）率分别为86.0%、79.6%和85.6%（P=0.314），无进展生存（PFS）率分别为76.5%、71.4%和74.1%（P=0.373）。诱导化疗期间，TPF组和GP组血液学毒性发生率显著高于TP组和PF组。结论对于局部晚期鼻咽癌患者，不同诱导化疗方案的疗效相似，以TPF和GP为代表的高强度诱导化疗方案并未带来整体生存获益。

Abstract:

Objective To analyze the efficacy of induction chemotherapy combined with intensity-modulated radiotherapy/concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma in the real world.Methods A retrospective analysis was performed on 821 newly treated patients with locally advanced nasopharyngeal carcinoma who received induction chemotherapy combined with radical radiotherapy/concurrent chemoradiotherapy in Hunan Cancer Hospital from January 2018 to January 2019. Induction chemotherapy regimens included TP, TPF, GP or PF. The efficacy and toxicity of different regimens were compared.Results The median follow-up time was 61.3 months (IQR 57.3~64.8 months). After propensity score matching (PSM), 5-year overall survival (OS) rate of the TP, TPF and PF group was respectively 85.8%, 79.6% and 81.6% (P=0.222). The local relapse-free survival (LRRFS) rate of the three groups was respectively 93.1%, 89.6%, and 91.9% (P=0.515). The distant metastasis-free survival (DMFS) rate of the three groups were 86.0%, 79.6%, and 85.6%, respectively (P=0.314). Progression free survival (PFS) rate of the three groups were 76.5%, 71.4%, and 74.1%, respectively (P=0.373). During induction chemotherapy, the incidences of hematological toxicity of the TPF and GP group were significantly higher than those of the TP and PF groups.Conclusion For patients with locally advanced nasopharyngeal carcinoma, the efficacy of different induction chemotherapy regimens was similar. High-intensity induction chemotherapy regimens represented by TPF and GP did not bring overall survival benefits for patients with locally advanced nasopharyngeal carcinoma.