期刊文献+

新辅助化疗联合同期放化疗治疗局部晚期鼻咽癌的毒副反应及近期疗效(英文) 被引量:29

Neoadjuvant chemotherapy followed by concurrent chemoradiation for locally advanced nasopharyngeal carcinoma
下载PDF
导出
摘要 Background and Objective:Concurrent chemoradiation therapy(CCRT) is the standard treatment for patients with locally advanced nasopharyngeal carcinoma(NPC).The effect of neoadjuvant chemotherapy followed by CCRT has not been determined.Therefore,we conducted 2 phase Ⅱ studies to evaluate the efficacy and safety of neoadjuvant chemotherapy with a regimen of docetaxel,cisplatin,and 5-fluorouracil(5-Fu)(TPF) followed by radiotherapy and concurrent cisplatin in patients with stage-Ⅲ and -Ⅳ(A -B) NPC.This article is the preliminary report on treatment-related toxicities and response.Methods:Graded according to the 2002 American Joint Committee on Cancer(AJCC) staging criteria,only patients with stage-Ⅲ or -Ⅳ(A-B) poorly differentiated or undifferentiated NPC(World Health Organization type Ⅱ/Ⅲ) were included.We planned to recruit 52 patients with stage-Ⅲ disease and 64 patients with stage-Ⅳ(A-B) disease.All patients received neoadjuvant chemotherapy with TPF(docetaxel 75 mg/m2,day 1;cisplatin 75 mg/m2,day 1;5-Fu 500 mg/(m2·day),continuous intravenous infusion for 120 h),every 3 weeks for 3 cycles,followed by weekly cisplatin(40 mg/m2) concurrent with radiotherapy.Three-dimensional conformal radiotherapy(3D-CRT) and intensity-modulated radiotherapy(IMRT) were used.Gross disease planning target volume(PTV),high-risk and low-risk subclinical PTV doses were prescribed at 70-76 Gy,66-70 Gy,and 60-61.25 Gy at 1.75-2.0 Gy per fraction.The lower neck or supraclavicular fields may be treated with conventional AP/PA fields for a total of 54 Gy at 1.8 Gy per fraction.Patients were evaluated for tumor response after the completion of neoadjuvant chemotherapy,and at 3 months after radiation according to the Response Evaluation Criteria In Solid Tumors(RECIST).The latest version of the National Cancer Institute's Common Terminology Criteria for Adverse Events(NCI CTCAE 3.0) was used for grading all adverse events.Results:Fifty-nine patients were evaluable for treatment response.Thirty patients had stage-III disease and 29 patients had stage-IV(A-B).All patients completed RT to the prescribed dose and 2 cycles of neoadjuvant chemotherapy,with 51 patients(86.4%) completing 3 cycles.A total of 50(84.7%) and 39 patients(66.1%) completed 4 weeks and 5 weeks of cisplatin during CCRT,respectively.The overall response rate in the primary site and the neck region were 94.9% [complete response(CR) in 25.4%] and 100%(CR in 19.6%) after completing neoadjuvant chemotherapy.At 3 months after RT,the CR rates increased to 96.6% and 90.2%,respectively.After a median follow-up of 14.3 months,we observed 5 treatment failures and 2 deaths.The 1-year overall survival,distant metastasis-free survival,and locoregional relapse-free survival rates were 100%,95.7%,and 97.7%,respectively.The rates of grade 3/4 myelosuppression and anorexia/nausea/vomiting during neoadjuvant chemotherapy were 55.9% and 16.9%,respectively.The corresponding rates were 11.9% and 23.7% during CCRT.Grade 3/4 mucositis,skin desquamation,and xerostomia occurred in 6.8%,44.1%,and 27.1% of patients,respectively.There were no treatment-related deaths.Conclusions:Neoadjuvant chemotherapy with TPF followed by CCRT was well tolerated with a manageable toxicity profile.Preliminary results are encouraging and warrant further investigation. Background and Objective:Concurrent chemoradiation therapy(CCRT) is the standard treatment for patients with locally advanced nasopharyngeal carcinoma(NPC).The effect of neoadjuvant chemotherapy followed by CCRT has not been determined.Therefore,we conducted 2 phase Ⅱ studies to evaluate the efficacy and safety of neoadjuvant chemotherapy with a regimen of docetaxel,cisplatin,and 5-fluorouracil(5-Fu)(TPF) followed by radiotherapy and concurrent cisplatin in patients with stage-Ⅲ and -Ⅳ(A -B) NPC.This article is the preliminary report on treatment-related toxicities and response.Methods:Graded according to the 2002 American Joint Committee on Cancer(AJCC) staging criteria,only patients with stage-Ⅲ or -Ⅳ(A-B) poorly differentiated or undifferentiated NPC(World Health Organization type Ⅱ/Ⅲ) were included.We planned to recruit 52 patients with stage-Ⅲ disease and 64 patients with stage-Ⅳ(A-B) disease.All patients received neoadjuvant chemotherapy with TPF(docetaxel 75 mg/m2,day 1;cisplatin 75 mg/m2,day 1;5-Fu 500 mg/(m2·day),continuous intravenous infusion for 120 h),every 3 weeks for 3 cycles,followed by weekly cisplatin(40 mg/m2) concurrent with radiotherapy.Three-dimensional conformal radiotherapy(3D-CRT) and intensity-modulated radiotherapy(IMRT) were used.Gross disease planning target volume(PTV),high-risk and low-risk subclinical PTV doses were prescribed at 70-76 Gy,66-70 Gy,and 60-61.25 Gy at 1.75-2.0 Gy per fraction.The lower neck or supraclavicular fields may be treated with conventional AP/PA fields for a total of 54 Gy at 1.8 Gy per fraction.Patients were evaluated for tumor response after the completion of neoadjuvant chemotherapy,and at 3 months after radiation according to the Response Evaluation Criteria In Solid Tumors(RECIST).The latest version of the National Cancer Institute's Common Terminology Criteria for Adverse Events(NCI CTCAE 3.0) was used for grading all adverse events.Results:Fifty-nine patients were evaluable for treatment response.Thirty patients had stage-III disease and 29 patients had stage-IV(A-B).All patients completed RT to the prescribed dose and 2 cycles of neoadjuvant chemotherapy,with 51 patients(86.4%) completing 3 cycles.A total of 50(84.7%) and 39 patients(66.1%) completed 4 weeks and 5 weeks of cisplatin during CCRT,respectively.The overall response rate in the primary site and the neck region were 94.9% [complete response(CR) in 25.4%] and 100%(CR in 19.6%) after completing neoadjuvant chemotherapy.At 3 months after RT,the CR rates increased to 96.6% and 90.2%,respectively.After a median follow-up of 14.3 months,we observed 5 treatment failures and 2 deaths.The 1-year overall survival,distant metastasis-free survival,and locoregional relapse-free survival rates were 100%,95.7%,and 97.7%,respectively.The rates of grade 3/4 myelosuppression and anorexia/nausea/vomiting during neoadjuvant chemotherapy were 55.9% and 16.9%,respectively.The corresponding rates were 11.9% and 23.7% during CCRT.Grade 3/4 mucositis,skin desquamation,and xerostomia occurred in 6.8%,44.1%,and 27.1% of patients,respectively.There were no treatment-related deaths.Conclusions:Neoadjuvant chemotherapy with TPF followed by CCRT was well tolerated with a manageable toxicity profile.Preliminary results are encouraging and warrant further investigation.
出处 《Chinese Journal of Cancer》 SCIE CAS CSCD 北大核心 2010年第5期551-555,共5页
关键词 Nasopharyngeal neoplasm concurrent/neoadjuvant CHEMOTHERAPY RADIOTHERAPY Nasopharyngeal neoplasm,concurrent/neoadjuvant,chemotherapy,radiotherapy
  • 相关文献

参考文献1

二级参考文献4

  • 1Teo P M,Int J Radiat Oncol Biol Phys,1999年,432卷,261页
  • 2Ma J,Chin J Cancer,1998年,18卷,增,44页
  • 3Min H,Int J Radiat Oncol Biol Phys,1994年,305卷,1037页
  • 4Zhang E P,Int J Radiat Oncol Biol Phys,1989年,162卷,301页

共引文献165

同被引文献176

引证文献29

二级引证文献245

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部