Concurrent Chemoradiotherapy Using Cisplatin and 5-Fluorouracil Alone or with Paclitaxel Followed by Adjuvant Cisplatin and 5-Fluorouracil in Nasopharyngeal Carcinoma

單獨使用順鉑及有利癌或合併太平洋紫杉醇並同步放射治療對於鼻咽癌患者治療結果分析

李仁正(Jen-Cheng Lee) ； 呂宜興(Yi-Shing Leu) ； 李振川(Jehn-Chuan Lee) ； 張義芳(Yi-Fang Chang) ； 黃明哲(Min-Jer Huang) ； 陳裕仁(Yu-Jen Chen) ； 陳虹汶(Hong-Wen Chen)

《中華民國癌症醫學會雜誌》 24卷6期 (2008/12) Pp. 372-379

https://doi.org/10.6588/JCOS.2008.24.6.5

摘要

背景：在鼻咽癌的治療上，目前最主要的治療方式是以同步執行化學治療及放射治療。而在化學治療的選擇上，最常被使用來治療鼻咽癌的是白金製劑(platinum-base agent)加上有利癌(5-fluorouracil)。而太平洋紫杉醇(Paclitaxel)被証實可用來治療復發及轉移的鼻咽癌。本回溯性研究分析即是針對這兩種不同的化學治療方式，提出治療結果整體存活率及無疾病存活率之比較。
方法：本研究採回溯性分析。自2002年1月至2004年12月，於馬偕紀念醫院頭頸癌治療團隊診斷為鼻咽癌的病人，累計共77例，接受同步執行化學治療及放射治療。在化學治療的藥劑當中，其中67例接受順鉑(cisplatin)加上有利癌治療（PF組），10例接受太平洋紫杉醇，順鉑加上有利癌治療(TPF 組)。平均追蹤期間為43個月。
結果：本研究發現鼻咽癌患者整體的5年存活率約為72%，PF組及TPF組分別為71%及80%。而5年無疾病存活率PF組及TPF組分別為64%及70%。皆無統計學上的差異。
結論：本研究無法證實太平洋紫杉醇，在鼻咽癌患者同步執行化學治療及放射治療的好處。同步順鉑，有利癌及放射治療目前仍是鼻咽癌患者的首選治療。

關鍵字

鼻咽癌 ； 同步化學放射治療 ； 太平洋紫杉醇

並列摘要

Purpose: The purpose of this study was to analyze the treatment outcome of patients with nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy (CCRT) with or without paclitaxel.
Materials and Methods: Seventy-seven patients with NPC received treatment at Mackay Memorial Hospital from 2002 to 2004. All of patients were treated with CCRT. Sixty-seven patients received chemotherapy of cisplatin and 5-fluorouracil (PF arm), and 10 patients received chemotherapy of paclitaxel, cisplatin and 5-fluorouracil (TPF arm). All patients received adjuvant PF after CCRT. Kaplan-Meier estimates were calculated for the overall and disease-free survival rates. Log-rank test was used to determine significant difference between the two arms.
Results: With a median follow-up of 43 months, 5-year overall survival rates (OS) and disease-free survival rates (DFS) for all patients were 72% and 65%, respectively. The 5-year OS in the PF arm and TPF arm were 71% and 80%, respectively (P=0.65). The 5-year DFS in the PF arm and TPF arm were 64% and 70%, respectively (P=0.61). There was no statistically significant difference between these two arms. Locoregional recurrence was found in 2 patients after the completion of treatment, and distant metastasis was found in 4 patients.
Conclusions: Our study failed to demonstrate the benefit of adding paclitaxel in CCRT of NPC. Standard PF regimen incorporated into radiation is still the treatment of choice for NPC.

並列關鍵字

nasopharyngeal carcinoma ； concurrent chemoradiotherapy ； paclitaxel