RESUMO
Objective To compare the short-term therapeutic effect, adverse reaction and influence on immune function between chrono-chemotherapy and routine-chemotherapy with docetaxel +cisplatin(DP)combined with concurrent chemoradiotherapy with cisplatin(DDP)in locally advanced(Ⅲ,Ⅳa stage)nasopharyngeal carcinoma(NPC).Methods 70 cases of newly diagnosed locally advanced NPC were randomly divided into group A and group B,35 cases in each group.Two groups of patients were treated with two cycles of neoadjuvant chemotherapy with DP combined with concurrent chemoradiotherapy with DDP.Both nereoadjuvant chemotherapy and concurrent chemotherapy of patients in group A were administrated with chrono-chemotherapy.Both nereoadjuvant chemotherapy and concurrent chemotherapy of patients in group B were administrated with routine-chemotherapy.Therapeutic effect,adverse reactions and other indicators were observed in both groups.Results After 3 months,there was no sifnificant difference of short term total efficacy between two groups in nasopharyngeal primary tumor(35 cases vs.34 cases),cervical lymph node(32 cases vs.31 cases).The incidence of adverse reactions of marrow toxicity(WBC,Hb,PLT)in group A was lower than group B(P<0.05),the incidence of digestive tract(nausea and vomiting,diarrhea)in group A was lower than group B(P<0.05),while there was no significant difference in oral mucositis between two groups(P<0.05).The high creatinine incidence in group A was lower than group B(P<0.05).There was no significant difference in high blood urea nitrogen and high transaminase incidences between two groups.After treatment, the T lymphocytes ( CD3 +, CD4 +, CD8 +, CD4 +/CD8 +) had no change in group A,the T lymphocytes(CD3 +,CD4 +)in group B decreased significantly compared with pre-treatment(P<0.05),and were lower than group A(P<0.05).Conclusion Adverse reactions and the degree of decline in cellular immune function of chrono-chemotherapy are lower than routine-chemotherapy in locally advanced NPC.
RESUMO
Objective To retrospectively analyze the data of patients with T3N0-1M0 nasopharyngeal carcinoma (NPC) who underwent radiotherapy (RT) alone or concurrent chemoradiotherapy (CCRT), and to investigate the relationship between therapeutic modality and prognosis. Methods From January 2004 to December 2004, 781 patients with biopsy-proven newly diagnosed non-metastatic NPC were analyzed in Sun Yat-Sen University Cancer Center, who had MRI data of nasopharynx and neck. With restaged based on the Chinese 2008 staging system, 82 cases of T3N0-1M0 patients who were treated by RT alone or CCRT were enrolled. They were divided into group A (46 cases, RT) and group B (36 cases, CCRT). Results The clinical data was comparable between the two groups. The 5-year overall survival rate (OS) was 93.5 % (group A) and 100 % (group B)(P =0.046), while the 5-year disease-free survival rate (DFS) was 85.2 % (group A) and 91.7 % (group B) (P =0.498). N-Staging was the factor affecting the DFS. Stratified analysis showed that the 5-year OS of T3N0M0 patients was 94.7 % (group A) and 100 % (group B) (P =0.432), those of T3N1M0 patients were 92.6 %(group A) and 100 %(group B) (P =0.066), while the 5-year DFS was 73.7 % (group A) and 89.3 % (group B) (P =0.244). Multifactor analysis showed that CCRT was not the independent factor affecting the OS(HR =0.019; 95 % CI, 0 to 21.793), and N-stage was not the independent factor affecting the DFS (HR = 0.203; 95 % CI, 0.135 to 1.231×104). Conclusion For T3N0M0, NPC patients, CCRT is not superior to RT alone. Whether CCRT can improve survival of T3N1M0 NPC patients needs further study.
RESUMO
Objective To assess the efficacy and feasibility of neoadjuvant therapy of TPF regimen including docetaxel (TAX), cisplatin (DDP) and 5-fluorouracil (5-Fu) combined with concurrent DDP and radiotherapy (RT) in patients with local advanced nasopharyngeal carcinoma (NPC). Methods From April 2008 to May 2009, 40 patients with newly diagnosed UICC stage Ⅲ orⅣ local advanced NPC were enrolled. Patients were randomly assigned to group A(DDP every 3 weeks) and group B(DDP every week). Two cycles of induction chemotherapy with TAX 60 mg/m2 dl, DDP 60 mg/m3 dl and 5-Fu 600 mg/m2 dl-5 were given on a 3-weekly cycle, followed by RT and chemotherapy(group A: DDP 80 mg/m2 every 3 weeks for 2 times; group B: DDP 30 mg/m2 weekly for 6 times). Two-dimension conformal RT technique with 68-72 Gy/(34-36) fractions for 7 weeks was administered to the nasopharynx and 60-66 Gy/(30-33) fractions for 6-6.5 weeks to the node-positive area. Results 38 patients (78 Cycles) were evaluable for efficacy and toxicity. One patient in each group was excluded due to toxicity. 17 (17/19) patients of group A finished 2 cycles of planed DDP chemotherapy, while only 10 (10/19) patients of group B completed 6 weeks of planed DDP chemotherapy, 4 completed 5 weeks, 4 completed 4 weeks and 1 completed 2 weeks. Response to neoadjuvant TPF was as follows: 4 patients (10.5 %) achieved complete response(CR), 27(71.1%) achieved partial response(PR) and 7 (18.4 %) achieved stable disease (SD), so the overall response (CR+PR) rate was 81.6 %. After RT, 32 patients (84.2 %) achieved CR, 5 (13.2 %) PR and 1 (2.6 %) SD, so the overall response rate was 97.4 %. Conclusion TPF induction chemotherapy followed by concurrent DDP and RT is an effective regimen in the treatment of advanced NPC. Concurrent DDP chemotherapy on a 3-weekly cycle is recommended. Further study should be made to investigate how to increase the dose intensity of chemotherapy.